Long-acting injectables for management of bipolar disorder in cerebral palsy-a case report

Cerebral palsy (CP) is a neurodevelopmental disorder characterized by permanent and non-progressive brain injury, typically associated with motor impairments and epilepsy. Psychiatric manifestations, though prevalent, often remain underrecognized and undertreated in patients with CP. Treatment choices in these individuals are particularly challenging due to their complex clinical presentations and increased vulnerability to medication side effects. While long-acting injectable antipsychotics (LAIAs) are established treatment options for various psychiatric conditions, evidence supporting their use in patients with CP is notably scarce. A 24-years-old patient with spastic quadriplegia presented with complaints of increased energy and grandiosity. She is a known case of bipolar disorder which was diagnosed at the age of 15 after overshadowing of symptoms for a long time. Despite these challenges she remains to be a high functioning adult pursuing college degree and continues participating in physical, occupational, language and speech therapy. In spite of trial of different antipsychotics and mood stabilizers, they failed to stop the cycling of moods. She also mentions unique effects of mood on her muscle spasticity and strength. She was started on Risperidone LAI which helped improve her mood and was apparent on the mental status examination after 2 weeks. This case highlights the promising role of LAIA formulations in psychiatric management of individuals with CP and this represents the first documented use of a LAIA in a CP patient with bipolar disorder. Further longitudinal studies are necessary to substantiate the long-term safety and efficacy of LAIAs in this special patient population.