Objective:

To explore the pharmacologic management of post-traumatic aggression in a pediatric patient with traumatic brain injury (TBI) and assess the efficacy of long-acting injectable paliperidone, with a focus on its potential benefits and challenges.

Key Findings:

• Long-acting injectable paliperidone significantly reduced aggression and improved functional status over two years, suggesting its potential as a first-line treatment.
• Cognitive testing at age 19 revealed average intellectual ability but persistent executive dysfunction, indicating the need for ongoing support.
• Adverse effects were limited to weight gain and asymptomatic hyperprolactinemia, with no serious complications reported.

Interpretation:

LAI paliperidone may be an effective treatment option for severe post-traumatic confusional state-related behavioral dysregulation when oral medication adherence is poor, highlighting the importance of tailored pharmacological strategies.

Limitations:

• Spontaneous recovery and developmental maturation cannot be excluded as contributing factors, necessitating cautious interpretation of results.
• Limited evidence from controlled studies on the efficacy and safety of LAI antipsychotics in pediatric TBI underscores the need for further research.

Conclusion:

This case suggests that LAI paliperidone can stabilize severe behavioral dysregulation in pediatric TBI, warranting further research on its long-term effects and broader applicability in clinical practice.