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Final Program

Pediatrics

816 - Exploring the Role of Donepezil in Pediatric Neurorehabilitation Following Severe Traumatic Brain Injury: A Case Report

Friday, February 20, 2026
5:00 PM - 6:30 PM AST

    Presenting Author(s)

  • AK

    Abrar Khazi, BS

    Medical Student
    Paul L. Foster School of Medicine - Texas Tech University Health Sciences Center El Paso
    El Paso, Texas, United States

    • Co-Author(s)

  • LS

    Lydia Singerman, MD

    Fellow
    CHOP
    Philadelphia, Pennsylvania, United States

  • JP

    Juan A. Polanco, MD, MS

    Resident Physician
    University of Pennsylvania Health System PM&R Program
    Philadelphia, Pennsylvania, United States

    • Corresponding Author(s)

  • DD

    Dawn Deike, DO

    Attending Physician
    CHOP
    Philadelphia, Pennsylvania, United States

    • Submitter(s)

  • AK

    Abrar Khazi, BS

    Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso
    El Paso, Texas, United States

Case Diagnosis: Severe traumatic brain injury (TBI) with cognitive impairment, treated with donepezil

Case Description: A 15-year-old male with no significant past medical history sustained multiple injuries after being struck by a car while riding a bicycle unhelmeted. Initial Glasgow Coma Scale was 4, improving to 8 with spontaneous movement of all extremities and reactive pupils. Imaging revealed multicompartment intracranial hemorrhages, bilateral temporal bone fractures, and a right sphenoid skull base fracture. Repeat head CT showed bilateral subdural hematomas with worsening mass effect and multifocal hemorrhages.  Upon inpatient rehabilitation admission, he presented with Rancho Los Amigos Level IV (emerging V) and post-traumatic confusional state marked by disorientation, memory impairment, distractibility, restlessness, impulsivity, impaired judgment, and severe aphasia. Trazodone improved agitation and restlessness, though cognitive and speech deficits persisted. Donepezil 5 mg daily was initiated, after which his Orientation Log (O-Log) improved from 7 to 11 and then 20 within one week, while his Cognitive and Linguistic Scale (CALS) score increased from 59 to 77.

Discussions:

Donepezil, a cholinesterase inhibitor, has shown potential benefit in adults with TBI-related cognitive dysfunction, though pediatric data remain limited. This case highlights its off-label use in a pediatric patient with severe TBI, where improvements in speech, responsiveness, and memory were observed within 24 hours and sustained over one week. Objective gains supported these findings, with O-Log and CALS improvements. While recovery was multifactorial and supported by therapies, this case suggests cholinergic augmentation may offer an additional therapeutic option when standard approaches are insufficient.

Conclusions: This case illustrates substantial recovery in a pediatric patient with severe TBI, with rapid improvements in communication and engagement following initiation of donepezil. These findings highlight the value of objective outcome measures in tracking recovery and support further study of cholinergic therapies in pediatric neurorehabilitation.