1. sign 2. groan 3. reply 4. thrown 5. strike 6. mighty 7. stroll 8. compose 9. dough 10. height 11. excite 12. apply 13. slight 14. define 15. odor 16. spider 17. control 18. silent 19. brighten 20. approach 21. sigh 22. twice 23. thrown 24. tonight 25. remote 26. require 27. reproach 28. defy 29.

Filipinos are known for some traditions which form part of our Culture. They are deeply set in our way of life. They form part of our Family living. 1. Saying “PO” and “OPO” – is a way of showing your respect to elders or superior as well as to strangers. Home Economics and Livelihood Education 7 Seibo College 71 If you have any questions, you can go to your learning facilitator, but if everything is clear to you, proceed to the next activities. 2. Close Family ties - Even though children are grown-up with their own family, still they participate in helping their parents through providing them financial support when necessary. 3. Hospitality - is a popular trait among Filipinos. Any guest arriving upon our home is well entertained. 4. Calling your elder brother “Kuya”, “Manong”, or “Diko”and elder sister “Ate”, “Ditse” is a sign of respect

1.Linguistics is the science that studies language. 2.Linguist:Someone who studies linguistics. 3.The Subfields of Linguistics Phonetics deals with the sounds of language. Phonology deals with how the sounds are organized. Morphology deals with how sounds are put together to form words. Syntax deals with how sentences are formed. Semantics deals with the meaning of words, sentences, and texts. Pragmatics deals with how sentences and texts are used in the world (i.e., in context) Text Linguistics deals with units larger than sentences, such as paragraphs and texts. 4.Prescriptive: This approach consists basically of stating what is considered right and wrong in language. 5.Descriptive: This approach, on the other hand, consists of describing the facts. Descriptive linguistics is dedicated to describing the rules of the language, and the language is seen as essentially rule governed. 6.Language is rule-governed, creative, universal, innate, and learned, all at the same time. 7.Linguists understand language as a system of arbitrary vocal signs. 8.Linguistic signs: involve sequences of sounds which represent concrete objects and events as well as abstractions.Signs may be related to the things they represent in a number of ways. 9.Iconic: which resemble the things they represent (as do, for example, photographs, diagrams, star charts, or chemical models). 10.Indexical: which point to or have a necessary connection with the things they represent (as do, for example, smoke to fire, a weathercock to the direction of the wind, a symptom to an illness, a smile to happiness, or a frown to anger). 11.Describe the characteristics of human language: Creative: (The structural elements of human language can be combined to produce new utterances, which neither the speaker nor his hearers may ever have made or heard before.) Rule-governed: (Language is made of rules.) Universal: (There are some aspects that are present in all languages of the world.) Innate:(all humans possess an innate capacity for language, activated in infancy by minimal environmental stimuli. Chomsky) Uniquely human: (Language is what sets us apart from other species. It is what makes us human.) Learned:(Children acquire language from their natural setting.) 12.Differentiate between iconic, indexical and symbolic signs. A. iconic, which resemble the things they represent (as do, for example, photographs, diagrams, star charts, or chemical models) B. indexical, which point to or have a necessary connection with the things they represent (as do, for example, smoke to fire, a weathercock to the direction of the wind, a symptom to an illness, a smile to happiness, or a frown to anger). c. symbolic, which are only conventionally related to the thing they represent (as do, for example, a flag to a nation, a rose to love, a wedding ring to marriage). 12. Distinguish between different senses of the grammar word. The prescriptivist´s grammar (Grammar is a set of rules that label the different utterances as either right or wrong.) The descriptivist´s grammar (Grammar is a set of rules that govern the langauge spoken by people. ) The linguist´s grammar (Grammar is the subconscious knowledge of the set of rules that enables speakers to use the language) The speaker´s grammar (Grammar is the intrinsic linguistic knowledge within a native speaker) 13.Describe common fallacies about language and grammar: ►One type of grammar is simpler than another. ►Changes in grammar involve deterioration in a language ►Grammars should be logical and analogical (that is, regular) ►People must be taught the grammatical rules of their language. ►Only some languages have grammar. ►Grammars differ from each other in unpredictable ways. 14.Generality: All Languages Have a Grammar 15. Equality: All Grammars Are Equal 16.Changeability: Grammars Change Over Time 17. Universality: Grammars Are Alike in Basic Ways 18.Tacitness: Grammatical Knowledge Is Subconscious 19.Linguistics is defined as the study of language systems. It is the scientific study of language. 20.Historical approach:It is the study of language change. 21.Linguistic Competence: is the unconscious knowledge speakers of a language have about the system that enables them to create and understand novel utterances. 22.Performance: is the use of it. Performance is “the actual use of language in concrete situations.” 23.I-Language (internal language): which is the intrinsic linguistic knowledge within a native speaker. 24.E-Language (external language): which is the observable language—the output from a speaker. 25.Parole ('speech') refers to the concrete instances of the use of langue, including texts which provide the ordinary research material for linguistics. 26.Langue: 27.Language: is a system of communication that is non-stereotyped and non-finite; it is unlimited in its scope. 28.Grammar: to refer to a subconscious linguistic system of a particular type. Grammar makes possible the production and comprehension of a potentially unlimited number of utterances. 29.Communication and animals: Selecting a mode of communication (speech,writing, gesture). Delivering the symbols through a medium, a physical basis for communication, light, air, or ink. Decoding of the symbols to obtain the information. 30.SIGNS: Communication relies on using something to stand for something else. Words are an obvious example of this: You do not have to have a car, a sandwich, or your cousin present in order to talk about them—the words car, sandwich, and cousin stand for them instead. This same phenomenon is found in animal communication as well. 31.The signifier: A signifier is that part of a sign that stimulates at least one sense organ of the receiver of a message.A signifier can also be a picture, a photograph, a sign language gesture, or one of the many other words for tree in different languages. 32.The signified: The signified component of the sign refers to both the real world object it represents and its conceptual content. The first of these is the real world content of the sign, its extension or referent within a system of signs such as English, avian communication, or sign language. 33.Iconic signs or icons: always bear some resemblance to their referent. A photograph is an iconic sign; so too is a stylized silhouette of a female or a male on a restroom door. 34.Some iconic tokens: a. open-mouth threat by a Japanese macaque; b. park recreation signs; c. onomatopoeic words in English. 35.An indexical sign, or index, fulfils its function by pointing out its referent, typically by being a partial or representative sample of it. Indexes are not arbitrary, since their presence has in some sense been caused by their referent. For this reason it is sometimes said that there is a causal link between an indexical sign and its referent.The track of an animal, for example, points to the existence of the animal by representing a part of it. The presence of smoke is an index of fire. 36.Symbolic signs: bear an arbitrary relationship to their referents and in this way are distinct from both icons and indexes. Human language is highly symbolic in that the vast majority of its signs bear no inherent resemblance or causal connection to their referents, as the following words show. 37.Mixed signs Signs: are not always exclusively of one type or another. Symptomatic signs, for example, may have iconic properties, as when a dog opens its mouth in a threat to bite. Symbolic signs such as traffic lights are symptomatic in that they reflect the internal state of the mechanism that causes them to change color. 38.Signals: All signs can act as signals when they trigger a specific action on the part of the receiver, as do traffic lights, words in human language such as the race starter's "Go!", or the warning calls of birds. 39.SIGN STRUCTURE: No matter what their type, signs show different kinds of structure. A basic distinction is made between graded and discrete sign structure. 40.Graded signs convey their meaning by changes in degree. A good example of a gradation in communication is voice volume. The more you want to be heard, the louder you speak along an increasing scale of loudness. There are no steps or jumps from one level to the next that can be associated with a specific change in meaning. 41.Discrete signs are distinguished from each other by categorical (stepwise) differences. There is no gradual transition from one sign to the next. The words of human language are good examples of discrete signs. 42.A VIEW OF ANIMAL COMMUNICATION ►Largely iconic ►Largely symptomatic ►Little arbitrary ►Not deliberate ►Not conscious ►Not symbolic ►Stimulus bound

1. What is the meaning of the word "Izhaar"? A) To hide the sound B) To make it clear C) To change the sound D) To merge two letters 2. Which part of the body is used to pronounce Izhaar Halqi letters? A) The lips B) The tongue only C) The throat D) The nose 3. How many letters are there for Izhaar Halqi? A) 4 letters B) 6 letters C) 15 letters D) 2 letters 4. When do we apply the rule of Izhaar Halqi? A) When any letter comes after Meem Sakinah B) When an Izhaar letter comes after Noon Sakinah or Tanween C) When we see a Shaddah D) Only at the end of a Surah 5. Which of the following is NOT an Izhaar Halqi letter? A) Hamzah (أ) B) Haa (هـ) C) Baa (ب) D) 'Ayn (ع) 6. Which pair of letters comes from the deepest part of the throat (closest to the chest)? A) ع and ح B) غ and خ C) ء and هـ D) ق and ك 7. When you do Izhaar, do you make a long Ghunnah (nasal sound)? A) Yes, a very long one B) No, we pronounce the Noon clearly without extra Ghunnah C) Only if we want to D) Yes, for 2 counts 8. Which letter comes from the top part of the throat (closest to the mouth)? A) Khaad (خ) B) Haa (ح) C) Hamzah (أ) D) Meem (م) 9. What are the middle throat letters? A) ء and هـ B) ع and ح C) غ and خ D) ت and د 10. In the phrase "مَنْ عَمِلَ" (Man 'Amila), which rule is applied? A) Idghaam B) Ikhfaa C) Izhaar Halqi D) Iqlaab 11. Why do we do Izhaar in "مَنْ عَمِلَ"? A) Because the letter 'Ayn (ع) comes after Noon Sakinah B) Because it is easy to say C) Because Meem has a Fathah D) Because the Noon has a Shaddah 12. What does "Noon Sakinah" mean? A) A Noon with a Fathah B) A Noon with a Kasrah C) A Noon with no vowel (has a Sukoon) D) A double Noon 13. What is Tanween? A) A double vowel sign (Fathatain, Kasratain, Dammatain) at the end of a word D) A small Meem on top of a letter C) A stretching sign D) A stop sign 14. Can Izhaar Halqi happen within a single word? A) No, never B) Yes, it can happen in one word or between two words C) Only in short words D) Only in Surah Al-Fatihah 15. Look at the word "وَانْحَرْ" (Wanhar). What is the Izhaar letter here? A) Waw (و) B) Noon (ن) C) Haa (ح) D) Raa (ر) 16. In the Quran, what sign is usually placed on the Noon Sakinah to show it is Izhaar? A) A small circle or head of a Khaa (Sukoon sign) B) A Shaddah C) Nothing at all D) A little Meem 17. What happens to the Tanween vowels when there is Izhaar? A) They are written far apart from each other B) They are aligned perfectly parallel above/below each other C) One vowel is deleted D) They change color 18. Which of the following words contains an Izhaar Halqi rule? A) أَنْعَمْتَ B) مَنْ يَقُولُ C) مِنْ بَعْدِ D) كُنْتُمْ 19. Choose the group that contains ONLY Izhaar Halqi letters: A) ي ، ر ، م ، ل B) ء ، هـ ، ع ، ح ، غ ، خ C) ك ، ق ، ج ، د D) ب ، ت ، ث 20. In the phrase "عَذَابٌ أَلِيمٌ" ( 'Adhaabun Aleem), why is there Izhaar? A) Because Tanween is followed by Hamzah (أ) B) Because it ends with Meem C) Because the word is long D) Because of the letter Laam 21. What is the correct way to read "مِنْ حَكِيمٍ"? A) Mi---hakeem (hide the Noon) B) Min Hakeem (read Noon clearly and quickly) C) Mih-hakeem (mix them together) D) Mim-hakeem (change Noon to Meem) 22. "Ghain" (غ) and "Khaa" (خ) come from which part of the throat? A) Deep throat B) Middle throat C) Top throat D) The lips 23. If a Noon Sakinah is followed by the letter "هـ" (Haa), how do we pronounce it? A) Clear Noon B) Hidden Noon C) Double Noon D) Silent Noon 24. Which of these is a middle throat letter? A) ء B) خ C) ح D) هـ 25. Complete the sentence: Izhaar Halqi means to pronounce the Noon Sakinah or Tanween cleanly from its articulation point without any ________. A) Breathing B) Vowel (Harakah) C) Extra Ghunnah (nasalization) D) Stopping

Rules for this Class 1. Respect yourself, your classmates and your teacher. Refrain from using inappropriate language. Keep your hands to yourself. Raise your hand to speak. Listen to others and respect what they have to say. 2. Uniforms Must be worn at all times, you will not be allowed to enter class without one. Students will be sent to Jose or Maria to receive a uniform. 3. Seating Sit in the front of the class unless there are no available seats and sit in assigned seats. 4. Cleanliness Always clean up after yourself and return all borrowed items back to their rightful place. 5. Technology Protocols: Do not use the laptop other than for classwork. Use of Headphones and Phones are forbidden. 6. Materials for class Always come to class prepared with a notebook, folder, pens or pencil. 7. Plagiarism Copying other people’s work is forbidden. You must cite Direct Quotes or paraphrase words that aren’t your own. Colleges will suspend you for cheating. 8. Bathroom No Bathroom or Water the first ten minutes and last ten minutes of class. Students must sign the bathroom log before leaving and after they come back. 9. Always be engaged during class time. Participation Classwork Working with others 10. Follow Directions Always listen for directions or read the direction on the smartboard as well as your worksheet for directions.

Stages in the Sale of a Property Stage 1 – Getting to Instruction • Initial contact with the vendor: need to check the following: type of property, contact details of vendor, address of property/Eircode and purpose of the contact - sale or valuation? If a sale, does the vendor need a quick sale? Qualify the lead i.e. is the vendor buying another property? If an investment property, is the tenant in situ? Check if there is a folio number available and confirm the ownership of the property. Schedule the viewing. • Pre-viewing: Set up a file & record all info from initial contact on CRM system. Check the Property Price Register to help get a general idea of property valuation (subject to viewing, helps to display knowledge of area/market and set expectations for the vendor). Nature of property may affect pricing e.g. starter home vs. larger property with vendor seeking to downsize. Consideration for comparables may include similar/same location, size and condition of property, availability and type of parking, layout of property, plot size, orientation of garden, extensions undertaken etc. Nature of market conditions, state of wider economy, cost of capital and availability of credit may also be factors. • Appraisal/viewing: Bring an advertising pack/sales & marketing brochures. Walk through property with client, note nice features/selling points for the brochure, let the client talk about upgrades/specific features of the property. It is very important to listen to the vendor and build rapport. Confirm property details e.g. condition and layout, plot size, orientation of garden. Check for certificates of compliance for any extensions, planning permissions for conversions, right of way if applicable etc. Check if a BER available/provide details for approved assessors. Demonstrate your/the practice’s professional expertise, justify why you should get the instruction, discuss recent local sales and give your potential valuation. Discuss the sales fee, marketing fee and any additional charges e.g. professional photography, drone footage, virtual tours (walkthrough video, Matterport etc.) Ask how the vendor heard about you/your practice and why are they considering you for the sale. Where appropriate offer advice to help vendor increase potential sales price. (If possible, leave with signed Property Services Agreement/Letter of Engagement.) Thank you, send/email market appraisal, any queries/questions do get in touch and let the vendor know that we’ll be in touch in coming days. • Post appraisal – letter sent that pm/next morning with market appraisal; diary note to follow up. Check that market appraisal letter received and check for questions. If did not get sale, find out why not/debrief. If get the sale, email confirmation of instruction. Once PSRA sent and LOE returned signed = stage 2. Other details required – ID, proof of address, proof of ownership/title, solicitor details, BER certificate (refer to assessor if not available). All these should be uploaded to CRM. Stage 2 – Getting to ‘Sale Agreed’ Set up appointment to measure & photograph, note any special features e.g., upgraded kitchen, south-facing garden. Provide ideas for improving sales potential (declutter, painting, tidy garden etc. Check if has vendor potential buyers in mind already e.g., relations, friends, other parties interested. Seek vendor approval for photos/text of brochure. Check for access (tenants in situ/working from home etc) and confirm viewing times. If given a key for viewings – tag it! Check alarm codes & whether a sign is allowed on the property. Bring to market – upload to all websites e.g., daft/my home, in house websites and create window display. Match the property against your internal database of potential purchasers /CRM system. Set up appointments for viewings on CRM or arrange for open viewings. Confirm viewings with vendor & purchaser. Turn on lights, open windows, secure valuables, leave out brochures & business cards, bring viewings sheets to keep record of attendees. Introduce yourself and get attendee details. Let people view the property and address any questions. Point out key features. Record questions to be answered and any feedback from viewers. Ask are they selling property? Let viewers know of offers already received. Lock up/alarm property/close windows. Provide vendor with feedback on viewings - number of viewers / questions raised/overall reaction to property. Offers should be confirmed in writing & upload to on CRM/ offers will be input by bidders onto online bidding platforms ‘Proof of funds’ required for offers in some practices. Successful bidder will be chosen by vendor, who might want quick sale/no chain or prefer the highest bidder. Booking deposit will be sought from successful bidder. The amount varies by practice but must cover fees. Sales Advice Notice/letter should be sent to both solicitors (and may be cc’d to vendor/buyer or notify both that SAN have gone out). Booking deposit receipt should be issued. The BER certificate and report should go to the solicitor. Send requests for docs/info to successful bidder including steps they need to take to progress sale e.g., organise the bank valuation and/or schedule the survey. Once the deposit is paid the property is Sale Agreed, inform other bidders, and update all websites/sales board etc. Stage 3 – Getting to closing Access should be organised for the bank valuation/survey. Stay in touch with both solicitors ‘contract-chasing’ i.e., check when contracts are issued, signed and queries answered. Legal searches undertaken by the solicitors may include checking boundaries, land registry, title, rights of way, compliance certs etc. When contracts are signed 10% purchase price/booking deposit should be sent to the vendor’s solicitor. Once all queries satisfied = drawdown of mortgage/funding, house/life insurance in place. Title deeds will be requested once contract is signed. Decide final closing date. Check that the property taxes have been paid. Check that vendor has vacated the property. When vacant, conduct the final walkthrough and take final readings (MPRNs ). Check with solicitor if the drawn down funds h, and once received the solicitor gives authorisation to the estate agent to release the keys. The agent will do up invoice, send the balance of funds to solicitor and provide gift to purchaser. Finally remove sign, mark as sold on CRM, seek testimonials, upload to social media and close a/c on CRM

[t comes from the GREEK name "Epilepsia" which means "taking hold of or seizing". - It is a disorder characterized by: recurrent seizures. SEIZURES R ectment transient attacks of: R epresent: R esult from: ASSOCIATED WITH: somatic, psychic, or, autonomic clinical featmes. clinical features of abnormally hyperexcitable cortical neurons. paroxvsmal and excessive electrical neuronal discharges. EEG changes & may be disturbance of consciousness. same causes of convulsions 1. Idiopathic epile~ • It is the commonest cause. no cause can be detected ( 65 % ) • It may be associated with positive family history in some cases. • It starts in the l st & 2nd decades in the form of: -- Grand ma! epilepsy. Petit mal epilepsy. Myoclonic epilepsy. Atonic seizures. 2. Secondary epilepsy A. Local causes in the brain: l. Congenital: 2. Traumatic: cerebral palsy. a cause can be detected cerebral contusion or laceration. 3. Inflammatory: 4. Neoplastic: 5. Degenerative: 6. Vascular: encephalitis, brain tumours. mening1t1s, presenile dementia. brain abscess. stroke (especially hemon-hagic), hypertensive encephalopathy. B. General causes with secondary effects on the brain: I. Toxic: 2. Iatrogenic: 3. Metabolic: 4. Endocrinal: 5. Organ failure: 6. Heart disease: 7. Nutritional: - Alcohol, cocaine, lead. - Lidocaine, INH. - j glucose & ! glucose. - Hypoparathyroidism. - Hepatic failme. - Adam's Stoke's attacks. - Pellagra. - Botulism, tetanus. - Ambilhar, Amphetamine, Aminophylline. - j Ca & ! Ca. - Hype1thyroid crisis. - Renal failure. - Fallot's tetralogy. - j Na & ! Na. - Vitamin B6 deficiency. 8. Physical: 9. HYSTERICAL. - High fevers. - Heat stroke. 136 137 CLINICAL PICTURE 1. GENERALISED SEIZURES " Excessive electrical discharges from cortical neurons in BOTH hemispheres simultaneously " I. II. 1. Grand Mal Epile~: 1. Pre-ictal stage "attacks of tonic-clonic convulsions " (aura) It is a warning sign of a coming attack. It may be: • Somatic: • Psychic: • Autonomic: 2. Ictal stage Myoclonus, Hallucinations. Tachycardia, (seizure) Sudden loss of consciousness: Parasthesias. Sweating. for seconds to minutes. -- Tonic phase (few seconds) o The UL & LL: o o o o The HEAD: The JAWS: CYANOSIS: are extended. is retracted to one side & the eye balls rolled up. are firmly clenched, with biting of the TONGUE. due to impaired respiration. There may be incontinence of urine. Clonic phase (few minutes) o The UL & LL: o The HEAD: 3. Post-ictal stage - It may be: • Somatic: • Psychic: • Autonomic: Drug of choice: contract & relax repeatedly & rapidly. jerks forcibly. (sequelae) Todd's paralysis(< 24 hours, due to neuronal exhaustion). Confusion. Vomiting. Carbamazepine (Tegretol) or Phenytoin (Epanutin) Petit Mal Epilepsy: "attacks of loss of consciousness " " Absence " It starts in childhood & improves at puberty & usually disappears at the age of 20. 2. It is NOT PRECEEDED by aura & NOT FOLLOWED by sequelae. 3. It is usually PRECIPITATED by: hyperventilation 4. It is characterized by: or photic stimulation. sudden loss of consciousness of short duration (few seconds). 5. It may be associated with: • High frequency ( 50 attacks / day). • Falling to the ground without warning. • Jerky movements of the head & UL Drug of choice: (myoclonic petit mal). Valproate (Depakine) or Succinimide (Zarontin) 137 138 Ill. M oclonic Seizures: "attacks of involuntary clonic movements " - It is characterized by: sudden, jerky, shock-like INVOLUNTARY muscle contraction. • The jerks are bilateral contractions, mainly of the shoulders and arms. • However, some patients repmtjerking in the lower limbs, trunk, or head. - It may be of 2 types: - Occurs singly • Simple: • As a pait of: I Drug of choice: IV. Atonic seizures: (no loss of consciousness). - Grand mal epilepsy (aura). - Petit mal epilepsy. Valproate (Depakine) or Clonazepam (Rivotril) I - Transient attacks of brief loss of postural tone, often resulting in falls and injuries. 2. PARTIAL SEIZURES "Excessive electrical discharges from cmtical neurons in a ce1tain area in ONE hemisphere" A. Simple seizures: " No disturbance in consciousness " - The CP depends on the site of the hyperexcitable neurones in the cerebral cortex, whether in: "Motor area or Senso,y areas". 1. Motor fits: • Focal fits: • Motor jacksonian fits: 2. General Sensory fits: • Focal fits: • Sensory jacksonian fits: 3. Special Senso1y fits: • Visual hallucinations: • Auditory hallucinations: • Olfactory hallucinations: B. Complex seizures: - SITE: movement of part of a limb or the whole limb. movement of one side of the body (see before). parasthesia of part of a limb or the whole limb. parasthesia of one side of the body (see before). irritation of the visual sensory area. irritation of the auditory sensory area. initation of the uncus. " disturbance in consciousness " The hyperexcitable neurons are in the Temporal lobe "Temporal lobe epilepsy". - DURATION: The seizure lasts few seconds to few minutes. - The seizure starts with A ura, followed by A bsence, Automatism, Amnesia: 1. 2. 3. 4. A ura: A bsence: Automatism: A mnesia: Olfactory hallucinations, Deja-vu phenomenon, Sensation of fear. Absent patient with staring eyes (with no response to conversation). Involuntary Purposeless acts: motor ( eg, lip smacking, chewing) or verbal. No recalling of the seizure. 138 139 3. PARTIAL SEIZURES ~ GENERALISED SEIZURES " Partial seizures may spread to involve the whole brain .- secondarily generalised seizures " . HY-sterical epilepsY • Usually: • The cause: • Incidence: young neurotic Sj2 . psychological & there is no organic lesion. usually occurs in the presence of people. • It is associated with: • EEG: • It is not associated with: normal. • Missed ttt. • Menses. • Alkalosis. anxiety, palpitaion & hyperventilation. tongue biting or incontinence of urine. • Alcohol use & Drug abuse ( e.g. cocaine ). • S timulation by photons & Hyperventilation. • S leep deprivation & Stress & sudden withdrawal of antiepileptic drngs. INVESTIGATIONS 1. EEG: • It is the most specific test for epilepsy because it records the electrical activity of the brain. • It shows specific pattern: 2. LOCAL INVESTIGATIONS: "Epilepsy waves". "CT & MRI of the brain" • To identify or exclude a LOCAL CAUSE of seizures in the brain. 3. GENERAL INVESTIGATIONS: "Laboratory investigations" • To search for a GENERAL CAUSE of seizures, e.g. blood glucose. 139 140 TREATMENT A. General Measures: 1. 2. Moderation of the patient's physical activity. A void the precipitating factors ( Alcohol, hyperventilation, photic stimulation ...... ). 3. A ketogenic diet is encouraged because it will induce acidosis: - Acidosis is beneficial as it raises the threshold of stimulation of the brain cells. B. Specific Treatment: 2. 1. Treatment of the cause in secondary epilepsy. Anti-epileptic drugs: a) Always sta1t with one drug, then add another drug if there is no response. b) Always stop the drugs ONLY if: • The patient stays free of symptoms for at least 2 years. • The patient has a normal EEG. 3. Side effects of Anti-epileptic drugs: I . Skin rash. 2. 3. Bone marrow depression. Ataxia. Drug 1. Barbiturates (Pbenonobarbitone) 2. Hydantoin (Epanutin) 3. Carbamazepine 4. Clonazepam 5. Valproate 6. Succinamide ANTI-EPILEPTIC DRUGS NEW ANTI-EPILEPTIC DRUGS - These drugs are new dtugs that may be used in resistant seizures. 1. Lamotrigine: 200 - 400 mg/ day. 2. Felbamate: 3. Gabapentin: 400- 800 mg/ day. 600 - 1200 mg/ day. \ " General rules for use ": Dose 100-600 mg I day 100-600 mg / day 200-600 mg I day 2-6 mg I day 500-1500 mg I day 500-1000 mg / day Best indicated - Broad spectrum. - Not for petit mal. - Grand mal. - Motor Jacksonian fits. - Grand mal. - Motor Jacksonian fits. - Complex seizures. - Not for petit ma!. - Myoclonic. - Grand mat. - Broad spectrum. - Petit mat. 140 141 STATUS EPILEPTICUS DEFINITION - A medical emergency: 1. Repeated attacks of generalized convulsions, with lack of recove,y of consciousness, 2. Persistent attack of seizure lasting for at least 30 minutes. OR, - If the convulsions are not stopped rapidly, coma deepens & death may occur due to: heart failure or respiratory failure or brain damage or hyperpyrexia. - The most common causes are: sudden withdrawal of anti-epileptic drugs & stroke. TREATMENT A. General Measures: l. Take care of: " ABC " • Place the patient on the ground, to guard against falling from bed. • Mouth gag & 02 inhalation ( endo-tracheal intubation may be needed). • Record the vital signs regularly. 2. Take a sample of: - Venous blood: for the level of: - A.tierial blood: for the level of: 3. a nti-epileptic drugs, a lcohol. pH, p0 2, pC02, HC0 3. Give cerebral dehydrating measures: e.g. Frusemide, cone. Mannitol, Dexamethazone. B. Specific Treatment: - Phenytoin with diazepam (or clonazepam) immediately: 1. Phenytoin: 2. Diazepam: Clonazepam: seizures recur: 15 mg I Kg slow infusion. 5 mg slowly IV, to be repeated after 5 minutes if seizures recur: maximum dose: 20 mg. OR: 2 mg slowly IV, to be repeated after 5 minutes if maximum dose: 6 mg. - If seizures persist after 20 min. of Phenytoin & diazepam: 3. PHENOBARBITONE: - In resistant cases: 200 mg infusion. 4. GENERAL ANAESTHESIA: may be used.

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