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Grade 7 PE Chapter 10 Lesson 1 Badminton Flying the Bird High with Your Agility and Power

LESSON 4. Cellular Respiration • Define cellular respiration • Identify the stages of clan respiration You have just learned how the energy from the sun is captured, processed, and stored in the form of glucose. Cellular respiration, another important life process, is the means by which cells release the stored energy in glucose to make adenosine triphosphate (ATP). The primary goal of this life process is to convert stored energy into usable form, such as ATP, for the cells to carry out their functions. Cellular respiration involves several chemical reactions. The reactions can be summed up in the following equation: C6 H12 O6 + 602 ----- 6 CO₂ +6H₂O + ATP Glucose oxygen carbon dioxide water energy Aerobic respiration reactions, or cellular respiration that takes place in the presence of oxygen, can be grouped into three stages glycolysis, Krebs cycle, and electron transport chain (ETC). Stage 1: Glycolysis Glycolysis is the process that breaks down one molecule of 6-C glucose into 3-C pyruvates or pyruvic acids. It also releases four molecules of ATP. This process occurs in the cytoplasm of the cell. The following is the step-by-step process of glycolysis. Take note that several enzymes are involved in this process. 1. The first step of glycolysis requires energy. It can only proceed when the two ATP molecules donate energy to the glucose by transferring a phosphate group with the help of an enzyme, producing glucose 6-phosphate 2. Then, a specific enzyme promotes the rearrangement of the atoms, producing the fructose 6-phosphate. 3. The action of the enzyme in step 2 promotes the transfer of a phosphate group from another ATP molecule, forming fructose 1,6-bisphosphate. 4. The resulting fructose 1,6-bisphosphate molecules, with the help of another enzyme, splits into two molecules, each with three carbon backbones. These two sugars are dihydroxyacetone phosphate and glyceraldehyde 3-phosphate. 5. Another important enzyme then rapidly interconverts the molecules of dihydro-xyacetone phosphate and glyceraldehyde 3-phosphate. This produces two molecules of glyceraldehyde 3-phosphate or 3-phosphoglyceraldehyde (PGAL) 6. The succeeding step involves another enzyme-mediated action. The hydrogen (H) from PGAL is transferred to the oxidizing agent, nicotinamide adenine dinucleotide (NAD), which forms NADH. A phosphate (P) is also added from the cytosol of the cell to oxidize the two molecules of PGAL, forming two 1.3-bisphosphoglycerate. 7. A phosphate (P) from 1,3-biphosphoglycerate is transferred to ADP to form ATP. This happens for each of the two 1,3-bisphosphoglycerate. resulting to a yield of two ATP and two 3-phosphoglycerate molecules. 8. A phosphate is transferred from 3-phosphoglycerate molecules from the third carbon to the second carbon, forming 2-phosphoglycerate molecules A hydrogen atom and a hydroxyl ((OH) group is released, which then combines to form water (H2O). The removal of H2O from 2-phosphoglycerate results in the formation of 2- phosphoglycerate molecules. 9. A hydrogen atom and a hydroxyl ((OH) group is released, which then combines to form water (H2O). The removal of H2O from 2-phosphoglycerate results in the formation of two phosphoenolpyruvic acid (PEP) 10. Phosphate (P) from PEP is transferred to ADP (and forms ATP) and the final product, pyruvic acid. This reaction yields two molecules of pyruvic acid and two ATP molecules In summary, a single glucose molecule that undergoes the process of glycolysis produces two molecules of pyruvic acid, four molecules of ATP, two molecules of NADEL and two molecules of H.O. However, only two molecules of ATP are counted as net products since two molecules of ATP are spent throughout the process. Stage II: Krebs Cycle The Krebs cycle, named after its proponent Sir Hans Adolf Krebs, is a cyclical series of enzyme-controlled reactions. This stage of cellular respiration occurs in the matrix of the mitochondria. It is sometimes. called the citric acid cycle (CAC) since it produces citric acid. Citric acid contains three carboxyl (COOH) groups; hence, it is also called the tricarboxylic acid cycle (TCA). This requires the pyruvic acids produced during glycolysis. The main function of this cycle is to produce high-energy-yielding molecules, namely, NADH and flavin adenine dinucleotide (FADH) that will later on be used in the electron transport chain reaction. Figure 6-7. Summary of glycolysis and corresponding products in each reaction presented (See Appendix F on page 285 for an enlarged and complete version of the image.) An initial process is needed for the Krebs cycle to begin. As a pyruvate molecule from glycolysis enters the mitochondrion, it undergoes an important preliminary ate to form acetyl-CoA reaction. Coenzyme-A (COA) combines with pyruvate help of an enzymatic complex. This conversion also produces CO, and NADH. The Krebs cycle is summarized as follows. Take note that several enzymes are involved in this process. 1. The Krebs cycle technically begins when the acetyl-CoA combines with oxaloacetic acid (OAA), a 4-C molecule, to produce citric acid, a 6-C molecule. 2. With the aid of an enzyme, the citric acid now goes through a series of reactions that releases energy. Water molecule is removed from the citric acid and is returned in a different location. The-OH group is repositioned, forming the molecule isocitrate. 3. Isocitrate is then oxidized, forming the a-ketoglutarate, a 5-C molecule. The byproducts of this reaction are NADH and CO, 4 The a-ketoglutarate loses its CO, and a coenzyme-A is added in its place. The decarboxylation occurs with the help of NAD, which then becomes NADH. The resulting molecule is called succinyl-CoA. 5. Succinyl-CoA is converted into succinate. Also in this reaction, a molecule of guanosine triphosphate (GTP) is synthesized. The GTP molecule has similar structure and energy properties to that of ATP and is used by cells the same way. The free phosphate group attacks the succinyl-CoA molecule, which detaches the COA. Then, phosphate is attached to GDP to come up with GTP, similar to the process that occur in ATP synthesis (from ADP to ATP). 6. Two hydrogens are removed from succinate, A molecule of flavin adenine dinucleotide (FAD), a coenzyme similar to NAD, is reduced to FADH, as it takes the hydrogens from the succinate. This reaction produces the fumarate. 7. Fumarate is then converted into malate as the addition of a water molecule is catalyzed. The final reaction is the regeneration of oxaloacetate. The resulting byproduct of this regeneration is NADH Recall that two pyruvate molecules were produced during glycolysis, causing the Krebs cycle to turn twice. Each tuts produces three molecules of NADH, single ATH one FADIH, and the by-product CO, which is exhaled. Stage III: Electron Transport Chain The electron transport chain (ETC) is a series of photon pumps on the inner membrane of the mitochondrion. Electron transport is the last stage of the cellular respiration. In this stage, the energy from NADH and FADH, from the Krebs cycle is transferred to ADP to produce ATP. This process is generally known as oxidative phosphorylation. This energy coupling mechanism in the cell was revealed by the work of Peter stored energy in the form of proton (1) gradient to phosphorylate (add phosphate) ADP and produce ATP. The pumping of hydrogen sons across the inner membrane creates higher concentration ions in the inner membrane than on the outside of the membrane. This chemiosmotic gradient causes the ions to flow back across the membrane where the concentration of ions is lower. ATP synthase lined in the matrix serve as a channel protein, helping the ions to move across the membrane. The chemiosmotic gradient powers the phosphorylation of ADP to ATP, which also occurs in the ATP synthase. After passing through the ETC, the oxygen, being the final hydrogen acceptor, combines with two electrons and two protons, forming a water molecule. Water is a by-product of cellular respiration and is excreted. MINI TEST 6-3 1. Which energy-releasing pathway yields the most ATF in each glucose molecule? 2. Briefly describe the two stages of aerobic respiration that follow glycolysis: (a) Krebs cycle (b) Electron transport chain Anaerobic Respiration Most cells carry out arrobic respiration when oxygen is present. Aerobic respiration is an efficient process that yields a lot of ATP. However, many organisms thrive in mud, marshes, animal gut, canned goods, sewage treatment pond, and deep oceans where oxygen is scarce. Organisms that can live without oxygen are called anaerobes. Cellular respiration that proceeds without the presence of oxygen is called anaerobic respiration. In the event that the oxygen supply becomes low, aerobic cells also perform fermentation and lactic acid fermentation anaerobic pathways. There are two common anaerobic pathways in these cells, alcoholic fermentation and lactic acid fermentation. In alcoholic fermentation, ethyl alcohol and carbon dioxide are produced by some cells using the pyruvate from glycolysis. Each pyruvate molecule is rearranged into acetaldehyde and carbon dioxide, which is eventually released. NADII gives up electrons to acetaldehyde to form ethanol Fermentation is widely used in the industry. Yeast, a fungus used in making bread. can undergo anaerobic respiration. Bakers aux sugar, flour, water, and yeast to form the bread dough. The dough rises due to the carbon dioxide and alcohol released by the yeast cells trapped in air bubbles. Beer and wine manufacturers, we yeast to ferment the sugars in wheat and grape juice, forming alcoholic beverages such as beer and wine. In some cells, glycolysis produces two pyruvates, two NADH molecules, and two ATP molecules. Pyruvate itself becomes the final acceptor of the electrons from the NADH that produces the final product: lactate. Oftentimes, this product is called lactic acid. Human skeletal muscles can carry out fermentation when the blood cannot supply the cells with adequate oxygen during strenuous activities. When lactic acid builds up in the muscles, fatigue, burning sensation, and cramps result. Lactic acid will continue to build up until there is adequate supply of oxygen. Lactic acid is then converted back into pyruvate in the liver. Muscles also restore normal functions. Have you ever wondered why milk or cream turns sour after some time? Bacterial cells that undergo fermentation are responsible in producing lactate that turns the milk sour. These bacteria are used in manufacturing yogurt and sour milk products. Fermentation pathways do not breakdown and utilize the glucose completely. ATP is no longer produced beyond the process of glycolysis. Thus, energy produced is just enough for some single-celled organisms, or the energy can only be used by multicellular organisms for a short period.

RPMS Quiz: Quality vs. Efficiency 1. A teacher spends five hours creating a highly interactive digital game for a single 40-minute lesson. This is an example of prioritizing: • A) Quality over Efficiency • B) Efficiency over Quality • C) Administrative Competence • D) Resource Management • Hint: The focus is on high-level engagement, but the time investment is very high. 2. Which of the following best describes "Efficiency" in the context of the RPMS? • A) Submitting all MOVs and reports on or before the deadline with minimal errors. • B) Ensuring 100% of students pass the quarterly examination. • C) Creating the most aesthetically pleasing portfolio in the department. • D) Conducting home visits for every single student in a class of 50. • Hint: Look for the option that emphasizes timeliness and resource use. 3. Using a "template" or a "reusable slide deck" for lesson planning is a strategy to improve: • A) Efficiency • B) Instructional Diversity • C) Subject Matter Mastery • D) Classroom Discipline • Hint: Templates reduce the time spent on repetitive formatting. 4. If a teacher provides detailed, personalized feedback to every student but submits the grades two weeks late, they have achieved: • A) High Quality, Low Efficiency • B) Low Quality, High Efficiency • C) High Quality, High Efficiency • D) Low Quality, Low Efficiency • Hint: The work itself is excellent, but the timing is poor. 5. Which tool improves Efficiency without sacrificing the Quality of assessment data? • A) Automated Google Forms for multiple-choice quizzes. • B) Giving everyone a passing grade to save time on checking. • C) Writing long paragraphs of feedback on 200 paper-based essays. • D) Skipping assessments entirely to finish the syllabus faster. • Hint: Look for a balance where technology handles the "busy work." 6. When discussing Quality in your RPMS portfolio, which "Means of Verification" (MOV) is most appropriate? • A) Sample of student work with constructive teacher comments. • B) A logbook showing you arrived at school at 7:00 AM daily. • C) A certificate for attending a 1-hour webinar. • D) A photo of your organized teacher's cabinet. • Hint: Quality is evidenced by the impact on student learning. 7. The concept of "Doing the right things" (Effectiveness) represents: • A) Quality • B) Efficiency • C) Speed • D) Compliance • Hint: "Doing the right things" is about results; "Doing things right" is about process. 8. How does "Efficiency" help a teacher maintain "Quality" in the long run? • A) It prevents burnout by optimizing workload, leaving energy for creative teaching. • B) It allows the teacher to take more side jobs. • C) It ensures the teacher never has to talk to parents. • D) It proves that the teacher is smarter than their peers. • Hint: Consider the relationship between teacher well-being and performance. 9. If a teacher's RPMS rating for Quality is 5 (Outstanding) but Efficiency is 2 (Fair), what is the most likely reason? • A) The teacher produces excellent work but often misses deadlines. • B) The teacher is very fast but makes many mistakes in their reports. • C) The teacher is both slow and produces poor results. • D) The students are failing despite the teacher being very organized. • Hint: Check the gap between the high-standard output and the slow delivery. 10. What is the ultimate goal of balancing Quality and Efficiency in the PPST-RPMS? • A) To achieve sustainable professional excellence that benefits the learners. • B) To get a higher salary increase only. • C) To impress the School Head during the observation. • D) To finish the school year with the least amount of work possible. • Hint: It's about long-term growth for both teacher and student. ________________________________________ Answer Key: 1. A | 2. A | 3. A | 4. A | 5. A | 6. A | 7. A | 8. A | 9. A | 10. A ________________________________________

1. Which factor is most crucial to verify first when selecting an ICT resource for instruction? A) Content alignment with the textbook B) Alignment with learning objectives C) The resource's popularity among peers D) Cost-effectiveness of the resource 2. When evaluating ICT resources, what is the purpose of checking cultural relevance? A) Ensuring it aligns with current trends B) Making sure it's accessible to all students C) Reflecting the diverse backgrounds of students D) Avoiding resources that are too complex 3. Which key aspect determines the accessibility of an ICT resource? A) How popular the resource is with students B) Its compatibility with existing technology C) Cost of using the resource D) Engagement levels it provides 4. In assessing content quality, why is accuracy important? A) To make resources easier to use B) To ensure alignment with curriculum standards C) To enhance visual appeal D) To provide a more engaging experience 5. Why is it essential for an ICT resource to offer interactivity? A) To improve download speeds B) To promote active learning and engagement C) To meet all technical requirements D) To minimize costs associated with the resource 6. What should be assessed regarding the usability of an ICT resource? A) How much it costs compared to other resources B) How easily students can navigate and use it C) How interactive it is D) Its level of engagement 7. Which of the following best describes the importance of feedback mechanisms in ICT resources? A) They reduce the need for grading B) They allow for automatic updates C) They provide immediate feedback to enhance learning D) They increase the cost-effectiveness of the resource 8. What is an advantage of resources that are scalable and flexible? A) They can adapt to different class sizes or teaching methods B) They are often free C) They do not require technical support D) They are easier to assess 9. Which tool would you use to gain structured feedback from students about an ICT resource? A) Rubrics B) Peer reviews C) Online review platforms D) Student feedback 10. When is a checklist most beneficial in evaluating an ICT resource? A) To provide structured guidelines for scoring B) For highlighting key features and requirements C) To measure student engagement D) To analyze technical support needs 11. Which of these tools helps teachers gather insights from colleagues on a resource's effectiveness? A) Online review platforms B) Student feedback C) Peer review D) Rubrics 12. In the planning stage, how can ICT benefit lesson development? A) By providing only audio resources B) By assisting in research for updated content C) By reducing the need for lesson objectives D) By limiting content access 13. During content delivery, how does ICT enhance the lesson experience? A) By allowing remote control of student devices B) By adding interactivity and visual elements C) By only focusing on text-based resources D) By limiting engagement 14. What is a key advantage of using ICT-based assessment tools? A) Reducing the need for reflection B) Tracking student progress and providing feedback C) Replacing lesson objectives D) Focusing solely on multiple-choice questions 15. Which ICT feature is most beneficial in the reflection stage of a lesson? A) Technical support options B) Feedback mechanisms for immediate assessment C) Tools for students to document learning, like online portfolios D) Interactive quizzes 16. How does ICT aid in skill development? A) By encouraging only memorization B) By fostering digital literacy and critical thinking C) By minimizing interactions with the teacher D) By restricting content variety 17. What does a cost-effective ICT resource entail? A) Being free of charge for all students B) Offering a good balance of educational value and cost C) Having the most features available D) Minimizing interactivity to reduce expenses 18. Why is teacher training crucial in ICT integration? A) To learn troubleshooting for technical issues B) To help only in the planning stage C) To reduce the need for ICT support D) To assess the cultural relevance of ICT tools 19. What challenge might schools face in accessing ICT resources? A) Lack of teacher motivation B) Availability of devices and internet connectivity C) High levels of student engagement D) Excessive interactivity 20. Why should teachers regularly evaluate the ICT resources they use? A) To determine if students enjoy using them B) To assess cost-effectiveness only C) To ensure resources remain effective and up-to-date D) To simplify lesson planning

The advantage of direct method is that the teacher can control the class and fit in a lot of activity into a short class period. This leaves plenty of opportunities for the students to hone their skills, especially new ones. On the other hand, because the class is centered around the teacher, some students may not receive proper feedback, and creativity is limited. Also, the lesser talented athletes often tend to get lost in the shuffle while the great athletes shine. However, there are now a multitude of various teaching strategies that can be employed in addition to that method. Ex: Announcements, Module/Unit introductions, Descriptions/modeling of assignments and learning activities, Written or video lectures, Demonstration videos, Presentations, Discussions moderated by instructors, Interactive tutorials. Indirect Method The Indirect Teaching Style allows students to be involved in their own learning through experience and other peer’s knowledge. Students can use critical thinking to expand their learning capabilities by seeing what others may be doing correct and adjusting this to their own knowledge. The Indirect approach is the opposite of what the direct style suggests, but they are both strictly related, meaning you can’t have one without the other. Direct teaching: The instructor stands in front of the class or group and lectures or advises. Indirect teaching: The instructor assumes a more passive role and guides the student interactions. Movement exploration: Incorporates the use of equipment that involves movement. Movement Exploration The movement exploration class is founded on developing a strong, positive association to physical activity. Classes are aimed at developing movement skills and foundational strength through fun and engaging activities. The activities are age appropriate and include games, challenges, and exploration that positively challenge children’s competency while improving their physical capabilities. Skills such as the ability to climb, hold animal shapes, gymnastic style activities, and the introduction to athletic motor skill competencies are the foundations to youth training. This class provides the introduction to strength training to give children the opportunity to learn the skills required to safely and confidently engage in resistance training. Cooperative Skills Cooperative activities teach students to work together for their group's common good. By participating in these activities, students can learn the skills of listening, discussing, thinking as a group, group decision making, and sacrificing individual wants for the common good. There are two primary objectives guiding the teaching of cooperative activities. First, cooperative activities allow students to apply a variety of fundamental motor skills in a unique setting. Students are typically asked to perform motor skills in a specific way, such as “skip in general space” or “balance on one foot and one elbow.” Cooperative activities ask students to perform different activities such as skip with their hands on the shoulders of someone in front of them, walk with big steps while placing their feet on small spots, or walk across an area blindfolded while someone directs their moves. Due to the uniqueness of such experiences, students often find cooperative activities exciting and motivating. Second, cooperative activities are a wonderful medium for teaching social and emotional learning (SEL). SEL offers students an opportunity to understand and manage their emotions. In addition, such activities offer an opportunity to show empathy for others and develop positive relationships. Cooperative activities demand that all students play a role in completing the task or solving the movement problem. Every student, regardless of ability level, is important and contributes to group goals. 9 traits a PE teacher often needs Here are nine essential traits of an effective PE teacher: 1. Athletic ability Athletic ability is an essential trait for a PE teacher because they're often showing kids how to perform exercises. To demonstrate proper form and encourage the kids to continue their fitness education, it's important they can perform the exercises themselves. Having experience with fitness training can enhance a PE teacher's lesson planning because they're familiar with how each exercise affects a person's body. Athletic ability can also refer to an aptitude for sports and games. PE teachers can instruct students on how to play these games or lead after-school activities involving them, like soccer or basketball. An aptitude for sports and games can help a PE teacher encourage students to participate in the activities during class. If the PE teacher enjoys physical activity, they may make the lessons more enjoyable for the student. 2. Teaching ability A PE teacher is a member of a school faculty, so it's essential they have the teaching ability that allows them to communicate lessons to students. There are various skills involved in teaching, including the technical capabilities associated with each professional's particular field. Learning these skills can help PE teacher plan their lessons effectively and connect with their students, meaning they can encourage students to practice fitness skills in optimal ways for their health. Here are some important teaching skills for PE teachers: Having an engaging classroom presence  Real-world learning  Project building  Lesson planning  Technology 3. Interpersonal skills PE coaches are part of faculty teams, so working alongside other teachers is an essential part of their job. They often collaborate with a student's general education teacher to address any behavioral issues that arise. They can also team up with other classes to plan activities for students, like field days and special field trips. Communicating with peers can ensure these interactions remain productive and create opportunities for more fulfilling lessons. Teachers can also model emotional skills for their students by displaying positive social interactions. Interpersonal skills can also help PE teachers interact with students and their families. If a student can make a student feel comfortable expressing their needs and preferences, they can often perform physical exercises or play games to the best of their individual capacities. Understanding how to soothe nerves and support students' emotional needs are important examples of interpersonal skills. When interacting with family members, you may use some of these same techniques to communicate effectively and best uplift students. 4. Written and verbal communication Both verbal and written communication is important for PE teachers because they often communicate with students, families and various personnel on a day-to-day basis. For example, a PE teacher uses their communication skills in a lesson plan to describe any student assignments or expectations accurately. They may also write instructions in a document, then explain them in a classroom lecture. They also use communication skills to share their lesson plans with other PE teachers during conferences or classroom development exercises. Many teachers continue to learn their trade even after working as a teacher for many years. They may share tips with each other or special lessons they've developed if they feel another teacher may benefit from it. Creating a community can help PE teachers continue to expand their teaching methodology and receive feedback on their lessons. 5. Patience and adaptability Working with children can require patience and adaptability because they're encountering many new concepts at the same time and learning how to regulate their emotions. As a result, it's important to treat them with patience and care while they're in your class so they can feel comfortable and feel motivated to complete assignments. As children become teenagers, they may require patience and adaptability to account for their changing bodies and attention spans. Like any job where you perform tasks in real-time, certain circumstances may occur that require you to adapt lesson plans. For example, if the weather turns from sunshine to rain on a day you planned for students to run a mile outside, you may need to adapt the lesson plan so they can practice endurance sports inside a gymnasium instead. 6. Organization PE teachers can use organization skills to improve their lesson planning sessions. For example, they can keep their plans in one place, and determine which parts of a semester or quarter to introduce new concepts. Throughout the year, these objectives may change because of unforeseen setbacks, but organizational skills can help PE teachers control the trajectory of their class curriculum. PE teachers can also use organizational skills to maintain their classroom space. Physical education frequently requires balls, equipment and tools to play games that may be on a lesson plan. They also organize equipment and decide where to store it within their classroom or storage space. 7. Creativity Creativity can help a PE teacher develop fun ways to introduce new material to their students or reinforce previous lessons. They can teach new games or devise interesting ideas to change the rules of a game to help keep students engaged. To find inspiration for their lesson plans, they can turn to personal hobbies or media aspects they enjoy, like movie scenes, songs or dances. A varied lesson plan can foster more engagement among students who prefer action- based learning activities, rather than lectures. 8. Focus Focus is an essential trait of a PE teacher because students often require their full attention during class, especially if they're learning a complicated physical task. You can focus your lesson plans around specific elements of physical education you believe are essential for students of a certain age group or skill level. If students require mentorship, you can also focus on each student's needs to supply them with a steady support system. Focusing on your students can help guide your career purpose. It can give you a core value system that informs your lesson plans and mentorship activities. This passion for your student's well-being can also help you become an advocate for each student in your class. You can also help organize funding for different field trips or establish after-school activities to support their interests. 9. Enthusiasm for teaching sports and fitness Enthusiasm is essential for a PE teacher. Many physical education activities require high energy and may suit someone who enjoys teaching them to others. Being an effective PE teacher also requires an enthusiasm for working with kids and making a positive impact on their lives.

[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.

lesson 1.7

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