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Teen diagnosed with PDD-NOS, has an aracnoid cyst in left temporal lobe, developed typical absence seizures. When shall we discontinue the drug?

Hi. My brother is diagnosed with PDD-NOS he is 15 years old and has an aracnoid cyst in left temporal lobe. He developed typical absence seizures last year and was prescribed trioptal 300mg twice a day. Its been 10 months since he is taking medication . He has one or two seizures after taking medication otherwise no reports of it. When shall we discontinue the drug? Or is it goin to be with him forever? Thanks
Asked On : Wed, 24 Apr 2013
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Neurologist 's  Response
your brother has arachnoid cyst L) temporal lobe.Arachnoid cysts are cerebrospinal fluid covered by arachnoidal cells and collagen that may develop between the surface of the brain and the cranial base or on the arachnoid membrane, one of the three membranes that cover the brain and the spinal cord. Arachnoid cysts are a congenital disorder
Your brother has to continue trioptal .Dose of drug has to be titrated as per body weight and clinical symptoms ( headache and seizure).Maximum dose is 40mg/kg body weight.If seizure occur with maximum dose then second antiepileptic drug has to be added.He require serial CT scan brain every 6 months to asses the size of arachnoid cyst, any temporal lobe hypo development , any hemorrhage or mass effect. In view of structural lesion he requires life long medicine.

Most arachnoid cysts are asymptomatic and do not require surgical treatment. Treatment may be necessary when symptomatic. A variety of procedures may be used to decompress (remove pressure from) the cyst.
Surgical placement of a cerebral shunt:
An internal shunt drains into the subdural compartment.
A cystoperitoneal shunt drains to the peritoneal cavity.
Craniotomy with excision
Various endoscopic techniques are proving effective,including laser-assisted techniques.
Drainage by needle aspiration or burr hole.
Capsular resection

Dr Sandhya Manorenj
Hi Tech city, Hyderabad
Answered: Fri, 10 May 2013
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