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[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.

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. Multiple Choice** 1. When do children in England and Wales usually go to nursery school? a) At age 2 b) At age 3 or 4 c) At age 5 d) At age 7 **Answer:** b) At age 3 or 4 2. How many years do children stay in primary school? a) 4 years b) 5 years c) 6 years d) 7 years **Answer:** c) 6 years 3. At what age do students start secondary school? a) 5 b) 9 c) 11 d) 13 **Answer:** c) 11 4. When can students leave school if they don’t want to continue? a) At 14 b) At 15 c) At 16 d) At 18 **Answer:** c) At 16 5. What is a mixed school? a) A school for boys only b) A school for girls only c) A school for both boys and girls d) A school for older students only **Answer:** c) A school for both boys and girls --- **2. True or False** 6. Students usually have to study between the ages of 5 and 18. **Answer:** True 7. University usually lasts one year. **Answer:** False (it usually lasts 3 or 4 years) 8. Some parents pay for private schools, but most children go to state schools. **Answer:** True 9. At age 16, students take A-level exams. **Answer:** False (they take GCSE exams at 16, A-levels later) --- **3. Short Answer** 10. What three main subjects do all students study until Year Eleven? **Answer:** English, Maths, and Science 11. What exams do students take at age 16? **Answer:** GCSE exams 12. What do students have to do a lot before exams? **Answer:** Revise (study) 13. What can students do if they fail an exam? **Answer:** Retake the exam 14. What is another word for a “state school” in Britain? **Answer:** Public school ---

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