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General test on Un. (8)
Quiz by Mr.mohamed Abdullah
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الحروب هي السبب الرئيسي لدمار اقتصاد كثير من الدول لانها تكرس كل مواردها البشريه والزراعيه والصناعيه لهذا الغرض بالاضافه الى ذلك يفقد كثير من الابرياء ارواحهم
All living creatures need to cooperate in order to achieve their goals. Teamwork, which means the ability of a group to work wee together, is something we cannot do without. Teamwork, together with tolerance, is essential for the success of any project
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PRE-TEST ON GENERAL AUDIT PROCEDURES WIDA ACCESS test: Questions on Writing and General InformationQuestion 1: What is the primary purpose of using rubrics in assessment? A. To reduce the number of assignments teachers must grade B. To give students random feedback C. To assess learner performance using specific criteria and levels D. To make grading faster and easier for instructors Question 2: Which of the following is a characteristic of analytic rubrics? A. Assess the entire task as a whole B. Provide a single descriptive paragraph for all criteria C. Use multiple criteria with individual performance descriptors D. Do not include any scoring scale Question 3: What is one benefit of using rubrics in education? A. They eliminate the need for grading B. They confuse learners about expectations C. They help provide informative and constructive feedback D. They discourage students from revising their work Question 4: When choosing between an analytic and a holistic rubric, which is true? A. Holistic rubrics provide detailed feedback for each component B. Analytic rubrics assess the task as a whole C. Holistic rubrics are used to give a general judgment of overall performance D. Analytic rubrics are used when no feedback is needed Question 5: Which of the following is not a step in developing a rubric? A. Define the purpose of the learning task B. Choose rubric type C. Design final exam questions D. Write performance descriptors Question 6 What does “content validity” refer to in assessment instruments? A. The extent to which the test predicts future performance B. The extent to which test items cover the intended content C. How consistent the results of the test are over time D. The judgment of whether a test looks valid on the surface Question 7 Which type of reliability involves the consistency of scores given by two or more raters? A. Intra-rater reliability B. Test-retest reliability C. Inter-rater reliability D. Internal consistency Question 8 Which statistical method is used to confirm that all items measure the intended construct? A. Content mapping B. Guessing analysis C. Construct charting D. Confirmatory Factor Analysis (CFA) Question 9 According to the PDF, what is one way to increase the validity of an assessment instrument? A. Shorten the test to reduce variability B. Apply penalties for guessing C. Conduct a vetting session with experts D. Use the same rater for all responses Question 10 In the affective domain construct map, what is the highest level of affective behavior? A. Responding B. Valuing C. Characterisation D. OrganisationMake a test, with answers best on the following: Conduct an investigation to provide evidence that living things are made of cells; either one cell or many different numbers and types of cells. Supporting Content LS1.A: Structure and Function • All living things are made up of cells, which is the smallest unit that can be said to be alive. An organism may consist of one single cell (unicellular) or many different numbers and types of cells (multicellular). (MS-LS-1.1) Further Explanation: Emphasis is on developing evidence that living things are made of cells, distinguishing between living and non-living things, and understanding that living things may be made of one cell or many and varied cells. In multicellular organisms, the body is a system of multiple interacting subsystems. These subsystems are groups of cells that work together to form tissues and organs that are specialized for particular body functions. (MS-LS-1.3) Further Explanation: Emphasis is on the conceptual understanding that cells form tissues and tissues form organs specialized for particular body functions. Examples could include the interaction of subsystems within a system and the normal functioning of those systems. Organisms reproduce, either sexually or asexually, and transfer their genetic information to their offspring. (MS-LS-1.4) • Living things share certain characteristics. (These include response to environment, reproduction, energy use, growth and development, life cycles, made of cells, etc.) (MS-LS1.4) Further Explanation: Examples should include both biotic and abiotic items, and should be defended using accepted characteristics of life. Plants, algae (including phytoplankton), and many microorganisms use the energy from light to make sugars (food) from carbon dioxide from the atmosphere and water through the process of photosynthesis, which also releases oxygen. These sugars can be used immediately or stored for growth or later use. (MS-LS-1.5) Further Explanation: Emphasis is on tracing movement of matter and flow of energy. Supporting Content LS1.C: Organization for Matter and Energy Flow in Organisms • Within individual organisms, food moves through a series of chemical reactions (cellular respiration) in which it is broken down and rearranged to form new molecules, to support growth, or to release energy. (MS-LS-1.6) Further Explanation: Emphasis is on describing that molecules are broken apart and put back together and that in this process, energy is released and on understanding that the elements in the products are the same as the elements in the reactants. Organisms, and populations of organisms, are dependent on their environmental interactions both with other living things and with nonliving factors. (MS-LS-2.1) • In any ecosystem, organisms and populations with similar requirements for food, water, oxygen, or other resources may compete with each other for limited resources, access to which consequently constrains their growth and reproduction. (MS-LS-2.1) • Growth of organisms and population increases are limited by access to resources. (MS-LS-2.1) Further Explanation: Emphasis is on cause and effect relationships between resources and growth of individual organisms and the numbers of organisms in ecosystems during periods of abundant and scarce resources. Similarly, predatory interactions may reduce the number of organisms or eliminate whole populations of organisms. Mutually beneficial interactions, in contrast, may become so interdependent that each organism requires the other for survival. Although the species involved in these competitive, predatory, and mutually beneficial interactions vary across ecosystems, the patterns of interactions of organisms with their environments, both living and nonliving, are shared. (MS-LS-2.2) Further Explanation: Emphasis is on predicting consistent patterns of interactions in different ecosystems in terms of the relationships among and between organisms and abiotic components of ecosystems. Examples of types of interactions could include competitive, predatory, and mutually beneficial. Food webs are models that demonstrate how matter and energy is transferred between producers, consumers, and decomposers as the three groups interact within an ecosystem. Transfers of matter into and out of the physical environment occur at every level. Decomposers recycle nutrients from dead plant or animal matter back to the soil in terrestrial environments or to the water in aquatic environments. The atoms that make up the organisms in an ecosystem are cycled repeatedly between the living and nonliving parts of the ecosystem. (MS-LS-2.3) Further Explanation: Emphasis is on describing the conservation of matter and flow of energy into and out of various ecosystems, and on defining the boundaries of the system. Ecosystems are dynamic in nature; their characteristics can vary over time. Disruptions to any physical or biological component of an ecosystem can lead to shifts in all its populations. (MSLS-2.5) Further Explanation: Emphasis is on recognizing patterns in data and making warranted inferences about changes in populations, and on evaluating empirical evidence supporting arguments about changes to ecosystems. Biodiversity describes the variety of species found in Earth’s terrestrial and oceanic ecosystems. The completeness or integrity of an ecosystem’s biodiversity is often used as a measure of its health. (MS-LS-2.6) Supporting Content LS4.D: Biodiversity • Changes in biodiversity can influence humans’ resources, such as food, energy, and medicines, as well as ecosystem services that humans rely on—for example, water purification and recycling. (MS-LS-2.6) Supporting Content ETS1.B: Developing Possible Solutions • There are systematic processes for evaluating solutions with respect to how well they meet the criteria and constraints of a problem. (MS-LS-2.6) Further Explanation: Examples of ecosystem services could include water purification, nutrient recycling, and prevention of soil erosion. Examples of design solution constraints could include scientific, economic, and social considerations. Genes are located in the chromosomes of cells, with each chromosome pair containing two variants of each of many distinct genes. Each distinct gene chiefly controls the production of specific proteins, which in turn affects the traits of the individual. Structural changes to genes (mutations) can result in changes to proteins, which can affect the structures and functions of the organism and thereby change traits. (MS-LS-3.1) Supporting Content LS3.B: Variation of Traits • In addition to variations that arise from sexual reproduction, genetic information can be altered because of mutations. Though rare, mutations may result in significant changes to the structure and function of proteins. Changes can be beneficial, harmful, or neutral to the organism. (MS-LS-3.1) Further Explanation: Emphasis is on conceptual understanding that changes in genetic material may result in making different proteins. Organisms reproduce, either sexually or asexually, and transfer their genetic information to their offspring. (MS-LS-3.2) Supporting Content LS3.A: Inheritance of Traits • Variations of inherited traits between parent and offspring arise from genetic differences that result from the subset of chromosomes (and therefore genes) inherited. (MS-LS-3.2) Supporting Content LS3.B: Variation of Traits • In sexually reproducing organisms, each parent contributes half of the genes acquired (at random) by the offspring. Individuals have two of each chromosome and hence two alleles of each gene, one acquired from each parent. These versions may be identical or may differ from each other. (MS-LS-3.2) Further Explanation: Emphasis is on using models such as simple Punnett squares and pedigrees, diagrams, and simulations to describe the cause and effect relationship of gene transmission from parent(s) to offspring and resulting genetic variation. The collection of fossils and their placement in chronological order is known as the fossil record and documents the change of many life forms throughout the history of the Earth. Anatomical similarities and differences between various organisms living today and between living and once living organisms in the fossil record enable the classification of living things. (MS-LS-4.1, MS-LS-4.2) Further Explanation: Emphasis is on finding patterns of changes in the level of complexity of anatomical structures in organisms and the chronological order of fossil appearance in the rock layers. The collection of fossils and their placement in chronological order is known as the fossil record and documents the change of many life forms throughout the history of the Earth. Anatomical similarities and differences between various organisms living today and between living and once living organisms in the fossil record enable the classification of living things. (MS-LS-4.1, MS-LS-4.2) Further Explanation: Emphasis is on explanations of the relationships among organisms in terms of similarity or differences of the gross appearance of anatomical structures. Scientific genus and species level names indicate a degree of relationship. (MS-LS-4.3) Further Explanation: Emphasis is on inferring general patterns of relatedness among structures of different organisms by comparing diagrams, pictures, specimens, or fossils. Natural selection leads to the predominance of certain traits in a population, and the suppression of others. (MS-LS-4.4) Further Explanation: Emphasis is on using concepts of natural selection, including overproduction of offspring, passage of time, variation in a population, selection of favorable traits, and heritability of traits. In artificial selection, humans have the capacity to influence certain characteristics of organisms by selective breeding. One can choose desired parental traits determined by genes, which are then passed to offspring. (MS-LS-4.5) Further Explanation: Emphasis is on identifying and communicating information from reliable sources about the influence of humans on genetic outcomes in artificial selection (such as genetic modification, animal husbandry, gene therapy), and on the influence these technologies have on society as well as the technologies leading to these scientific discoveries. Adaptation by natural selection acting over generations is one important process by which species change over time in response to changes in environmental conditions. Traits that support successful survival and reproduction in the new environment become more common; those that do not become less common. Thus, the distribution of traits in a population changes. (MS-LS-4.6) Further Explanation: Emphasis is on using mathematical models, probability statements, and proportional reasoning to support explanations of trends in changes to populations over time. Examples could include Peppered Moth population changes before and after the industrial revolution. Extradition (International law), Political Offence Exception, The Political Offense Exception (POE) serves as a critical safeguard in international extradition law, allowing a requested state to refuse the surrender of a fugitive if their alleged crime is of a "political character." These offenses are categorized into two types: **pure political offenses**, such as treason or espionage, which target the state's political organization without harming individuals; and **relative political offenses**, which are common crimes like robbery committed with a political motive. To distinguish between these, courts apply various judicial tests. For instance, the **Political Incidence Test** (established in *In re Castioni*) focuses on whether the act was incidental to a political disturbance, while the **Swiss Proportionality Test** weighs the political end against the criminal means used, denying the exception if the harm caused is disproportionate. In the context of **state succession**, the application of extradition treaties depends largely on the underlying legal theory adopted by the new sovereign. Under **Universal Succession**, the new state inherits all prior treaties and obligations, ensuring legal continuity. Conversely, the **Clean Slate (Tabula Rasa) Theory**, often seen in decolonization, suggests that new states are not bound by the predecessor’s treaties, potentially creating "safe havens" for fugitives until new agreements are reached. Practical examples include the **Dissolution of the USSR**, where Russia acted as the "continuator" state inheriting treaties, and the **Partition of India and Pakistan**, where a devolution agreement ensured that colonial-era treaties remained in effect. Despite its protective intent, the POE faces **modern erosion** to ensure that heinous acts do not go unpunished. Specific limitations, such as the **Attentat Clause**, explicitly exclude the assassination of a head of state from being considered a political offense. Similarly, modern treaties and conventions (like the *Meunier* ruling) exclude **terrorism**, hijacking, and crimes against humanity from the exception, viewing these acts as attacks on the general social order rather than legitimate political dissent. This evolution reflects a growing international consensus that the gravity of certain crimes—such as those seen in the **Rainbow Warrior case study**—far outweighs any claimed political motivation, shifting the legal focus toward human rights and the prevention of torture. Question,Correct Answer,Option 2,Option 3,Option 4 You just saw your crush trip, but you imagine it in slow‑motion as if in a movie. What are you doing?,Visualizing,Ignoring,Running away,Screaming Your best friend says your outfit is “trash” but you think it’s ICONIC! This shows —,Perception,Precision,Symmetry,Association A butterfly’s wings are perfectly matching on both sides. They are —,Symmetrical,Random,Loud,Vague You always think of pizza when you hear “Friday night.” This is a(n) —,Association,Obsession,Illustration,Symmetry You carefully measure 10 candies for lunch. This shows —,Precision,Obsession,Symmetry,Association A teacher draws a big volcano on the board to explain it. She is —,Illustrating,Guessing,Visualizing,Ignoring Two students react differently to the same horror movie. This shows —,Perception,Symmetry,Precision,Obsession You measure your eyeliner perfectly on both eyes. This is —,Symmetry,Visualizing,Association,Individualized A student redoes ONE sentence 17 times all night. She is —,Obsessive,Relaxed,Careless,Confused A loud, clear knock on the door is —,Distinct,Vague,Random,Individualized You picture your future life as a superhero saving the world. You are —,Visualizing,Associating,Obsessing,Measuring A quiz made just for ONE student is —,Individualized,General,Random,Symmetrical Two students get the same task but react differently. This shows differences in —,Perception,Symmetry,Association,Obsession Your friend always folds napkins perfectly before dinner. That is —,Obsessive,Relaxed,Visualizing,Association A student triple‑checks a ruler, erases tiny mistakes, and won’t submit. Which TWO describe her? (Choose best single answer),Obsessive and Precise,Relaxed and Calm,Confused and Random,Symmetrical and Vague Which shows BOTH perception AND association?,Thinking rain is sad because you cried in it,Measuring carefully,Folding paper,Drawing a volcano The **funniest way to show symmetry** in class would be —,Balancing a pencil on your nose randomly,Throwing paper randomly,Screaming at the board,Balancing a pencil perfectly on your nose You hear a scary clear knock and spill your water. That knock is —,Distinct,Vague,Individualized,Symmetry Which is NOT individualized?,Standard school uniform,Custom shoes,Test for one student,Personalized notebook Two students measure carefully. One is calm and exact, the other keeps freaking out. The calm student shows —,Precision,Obsession,Association,Illustration The same scenario: The freaking‑out student shows —,Obsession,Symmetry,Visualizing,PrecisionFed. 51: To the People of the State of New York: TO WHAT expedient, then, shall we finally resort, for maintaining in practice the necessary partition of power among the several departments, as laid down in the Constitution? The only answer that can be given is, that as all these exterior provisions are found to be inadequate, the defect must be supplied, by so contriving the interior structure of the government as that its several constituent parts may, by their mutual relations, be the means of keeping each other in their proper places. Without presuming to undertake a full development of this important idea, I will hazard a few general observations, which may perhaps place it in a clearer light, and enable us to form a more correct judgment of the principles and structure of the government planned by the convention. In order to lay a due foundation for that separate and distinct exercise of the different powers of government, which to a certain extent is admitted on all hands to be essential to the preservation of liberty, it is evident that each department should have a will of its own; and consequently should be so constituted that the members of each should have as little agency as possible in the appointment of the members of the others. Were this principle rigorously adhered to, it would require that all the appointments for the supreme executive, legislative, and judiciary magistracies should be drawn from the same fountain of authority, the people, through channels having no communication whatever with one another. Perhaps such a plan of constructing the several departments would be less difficult in practice than it may in contemplation appear. Some difficulties, however, and some additional expense would attend the execution of it. Some deviations, therefore, from the principle must be admitted. In the constitution of the judiciary department in particular, it might be inexpedient to insist rigorously on the principle: first, because peculiar qualifications being essential in the members, the primary consideration ought to be to select that mode of choice which best secures these qualifications; secondly, because the permanent tenure by which the appointments are held in that department, must soon destroy all sense of dependence on the authority conferring them. It is equally evident, that the members of each department should be as little dependent as possible on those of the others, for the emoluments annexed to their offices. Were the executive magistrate, or the judges, not independent of the legislature in this particular, their independence in every other would be merely nominal. But the great security against a gradual concentration of the several powers in the same department, consists in giving to those who administer each department the necessary constitutional means and personal motives to resist encroachments of the others. The provision for defense must in this, as in all other cases, be made commensurate to the danger of attack. Ambition must be made to counteract ambition. The interest of the man must be connected with the constitutional rights of the place. It may be a reflection on human nature, that such devices should be necessary to control the abuses of government. But what is government itself, but the greatest of all reflections on human nature? If men were angels, no government would be necessary. If angels were to govern men, neither external nor internal controls on government would be necessary. In framing a government which is to be administered by men over men, the great difficulty lies in this: you must first enable the government to control the governed; and in the next place oblige it to control itself. A dependence on the people is, no doubt, the primary control on the government; but experience has taught mankind the necessity of auxiliary precautions. This policy of supplying, by opposite and rival interests, the defect of better motives, might be traced through the whole system of human affairs, private as well as public. We see it particularly displayed in all the subordinate distributions of power, where the constant aim is to divide and arrange the several offices in such a manner as that each may be a check on the other that the private interest of every individual may be a sentinel over the public rights. These inventions of prudence cannot be less requisite in the distribution of the supreme powers of the State. But it is not possible to give to each department an equal power of self-defense. In republican government, the legislative authority necessarily predominates. The remedy for this inconveniency is to divide the legislature into different branches; and to render them, by different modes of election and different principles of action, as little connected with each other as the nature of their common functions and their common dependence on the society will admit. It may even be necessary to guard against dangerous encroachments by still further precautions. As the weight of the legislative authority requires that it should be thus divided, the weakness of the executive may require, on the other hand, that it should be fortified. An absolute negative on the legislature appears, at first view, to be the natural defense with which the executive magistrate should be armed. But perhaps it would be neither altogether safe nor alone sufficient. On ordinary occasions it might not be exerted with the requisite firmness, and on extraordinary occasions it might be perfidiously abused. May not this defect of an absolute negative be supplied by some qualified connection between this weaker department and the weaker branch of the stronger department, by which the latter may be led to support the constitutional rights of the former, without being too much detached from the rights of its own department? If the principles on which these observations are founded be just, as I persuade myself they are, and they be applied as a criterion to the several State constitutions, and to the federal Constitution it will be found that if the latter does not perfectly correspond with them, the former are infinitely less able to bear such a test. There are, moreover, two considerations particularly applicable to the federal system of America, which place that system in a very interesting point of view. First. In a single republic, all the power surrendered by the people is submitted to the administration of a single government; and the usurpations are guarded against by a division of the government into distinct and separate departments. In the compound republic of America, the power surrendered by the people is first divided between two distinct governments, and then the portion allotted to each subdivided among distinct and separate departments. Hence a double security arises to the rights of the people. The different governments will control each other, at the same time that each will be controlled by itself. Second. It is of great importance in a republic not only to guard the society against the oppression of its rulers, but to guard one part of the society against the injustice of the other part. Different interests necessarily exist in different classes of citizens. If a majority be united by a common interest, the rights of the minority will be insecure. There are but two methods of providing against this evil: the one by creating a will in the community independent of the majority that is, of the society itself; the other, by comprehending in the society so many separate descriptions of citizens as will render an unjust combination of a majority of the whole very improbable, if not impracticable. The first method prevails in all governments possessing an hereditary or self-appointed authority. This, at best, is but a precarious security; because a power independent of the society may as well espouse the unjust views of the major, as the rightful interests of the minor party, and may possibly be turned against both parties. The second method will be exemplified in the federal republic of the United States. Whilst all authority in it will be derived from and dependent on the society, the society itself will be broken into so many parts, interests, and classes of citizens, that the rights of individuals, or of the minority, will be in little danger from interested combinations of the majority. In a free government the security for civil rights must be the same as that for religious rights. It consists in the one case in the multiplicity of interests, and in the other in the multiplicity of sects. The degree of security in both cases will depend on the number of interests and sects; and this may be presumed to depend on the extent of country and number of people comprehended under the same government. This view of the subject must particularly recommend a proper federal system to all the sincere and considerate friends of republican government, since it shows that in exact proportion as the territory of the Union may be formed into more circumscribed Confederacies, or States oppressive combinations of a majority will be facilitated: the best security, under the republican forms, for the rights of every class of citizens, will be diminished: and consequently the stability and independence of some member of the government, the only other security, must be proportionately increased. Justice is the end of government. It is the end of civil society. It ever has been and ever will be pursued until it be obtained, or until liberty be lost in the pursuit. In a society under the forms of which the stronger faction can readily unite and oppress the weaker, anarchy may as truly be said to reign as in a state of nature, where the weaker individual is not secured against the violence of the stronger; and as, in the latter state, even the stronger individuals are prompted, by the uncertainty of their condition, to submit to a government which may protect the weak as well as themselves; so, in the former state, will the more powerful factions or parties be gradnally induced, by a like motive, to wish for a government which will protect all parties, the weaker as well as the more powerful. It can be little doubted that if the State of Rhode Island was separated from the Confederacy and left to itself, the insecurity of rights under the popular form of government within such narrow limits would be displayed by such reiterated oppressions of factious majorities that some power altogether independent of the people would soon be called for by the voice of the very factions whose misrule had proved the necessity of it. In the extended republic of the United States, and among the great variety of interests, parties, and sects which it embraces, a coalition of a majority of the whole society could seldom take place on any other principles than those of justice and the general good; whilst there being thus less danger to a minor from the will of a major party, there must be less pretext, also, to provide for the security of the former, by introducing into the government a will not dependent on the latter, or, in other words, a will independent of the society itself. It is no less certain than it is important, notwithstanding the contrary opinions which have been entertained, that the larger the society, provided it lie within a practical sphere, the more duly capable it will be of self-government. And happily for the REPUBLICAN CAUSE, the practicable sphere may be carried to a very great extent, by a judicious modification and mixture of the FEDERAL PRINCIPLE. PUBLIUS. [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.