Qual è la funzione principale del pistone in un motore a ciclo Otto?

Comprimere la miscela aria-carburante nella camera di combustione

Gestire il flusso dell'aria all'interno del motore

Generare l'energia elettrica per l'accensione

Controllare la temperatura dell'olio motore

Qual è il principio fondamentale su cui si basa il funzionamento del motore a ciclo Otto?

Il ciclo termodinamico a quattro tempi

Il ciclo termodinamico a due tempi

Qual è il processo mediante il quale avviene il raffreddamento del motore a ciclo Otto?

Raffreddamento per evaporazione

Qual è il rapporto ottimale tra aria e carburante per una corretta combustione nel motore a ciclo Otto?

Rapporto stechiometrico di circa 14.7:1

Motore a ciclo otto

Il Simbolismo musicale in Francia La Francia è uno dei centri nevralgici della musica del ‘900. Parigi è dalla fine dell’Ottocento fino a tutta la prima metà del ‘900 il centro artistico per eccellenza. Tantissimi compositori passano per Parigi che è un centro di cultura internazionale dove si sviluppano tante delle avanguardie artistiche del periodo. Una serie di eventi particolarmente importanti che si sono svolto a Parigi nel corso della seconda metà dell’Ottocento e che ha influenzato molto anche la vita culturale sono le esposizioni Universali. Le esposizioni universali sono insieme fiere commerciali e mostre scientifico-culturali che vengono realizzate nelle più importanti città del mondo. Queste manifestazioni ricoprirono un ruolo molto significativo soprattutto nel periodo tra la seconda metà dell'Ottocento e i primissimi decenni del Novecento. Nelle grandi mostre-mercato ottocentesche venivano messi in vendita i prodotti esposti, dagli ascensori ai cannoni, dai telefoni ai motori a scoppio, ma allo stesso tempo venivano presentati ai visitatori, come si fa in un museo, i progressi scientifici raggiunti. Oltre ai progressi scientifici però vengono mostrati anche manufatti artigianali provenienti da tutte le parti del mondo. Il contatto con questi prodotti di culture diverse è un grandissimo stimolo per la cultura dei paesi che ospitano queste esposizioni e la musica risente tantissimo di questi contatti. Il primo esempio dell’influenza di questi nuovi contatti con culture lontane lo abbiamo in due compositori molto importanti che vivono tra la fine dell’800 e l’inizio del 900. Debussy e Ravel sono due esponenti di una delle correnti più importanti della musica francese il simbolismo musicale che si sviluppa in questo periodo. La musica ha come la funzione di rappresentare in maniera simbolica (quindi diciamo di evocare più che di rappresentare pedissequamente) stimoli di vario genere letterari, visivi (immagini, quadri, fotografie), uditivi (rumori ambientali, musiche tradizionali). Questo tipo di evocazione ha però il bisogno di distanziarsi dai suoni tradizionali che non sono più ritenuti adatti ad evocare delle immagini sonore forti. L’ispirazione arriva da una esposizione universale, quella del 1889. Come le Esposizioni hanno ispirato i Compositori Le strutture incredibili e le decorazioni delle esposizioni universali ispiravano i musicisti simbolisti. Opere architettoniche grandiose come la Torre Eiffel diventavano fonti di ispirazione per i compositori che cercavano di trasmettere attraverso la musica lo spirito innovativo e avventuroso di quei tempi. Questo li spingeva a esplorare nuovi suoni che potessero riflettere le meraviglie viste nelle esposizioni, creando musica che andava oltre il normale ascolto per evocare sentimenti e immagini. Il Gamelan Un momento decisivo per l’evoluzione della musica europea avviene durante l’Esposizione Universale di Parigi del 1889, quando il pubblico occidentale entra in contatto diretto con il Gamelan giavanese. Il gamelan è un insieme di strumenti prevalentemente a percussione, come gong, metallofoni e tamburi. La sua musica è organizzata in cicli ripetitivi e stratificazioni sonore, senza un sviluppo narrativo lineare. Non esiste una tensione armonica come nella musica tonale occidentale: il tempo musicale è circolare e il suono assume una funzione atmosferica. Questo incontro mostra ai compositori europei che è possibile pensare la musica in modo radicalmente diverso: senza armonia funzionale senza sviluppo tematico tradizionale privilegiando il timbro e la ripetizione L’influenza del gamelan non consiste nell’imitazione diretta, ma nell’assimilazione di un principio compositivo nuovo. La musica può essere statica, sospesa, evocativa, e tuttavia profondamente espressiva. Jardins sous la pluie Il brano Jardins Sous la Pluie è un brano per pianoforte composto da Debussy nel 1903 all’interno della raccolta denominata “Estampe” cioè stampe (in riferimento in particolare alle stampe giapponesi che si potevano ammirare nelle esposizioni universali). In questo brano attraverso l’uso di suoni molto veloci e staccati, che si ripetono a ondate sonore ora molto intense ora molto deboli, Debussy vuole rappresentare simbolicamente il rumore della pioggia sulle piante di un giardino. La musica eseguita durante le esposizioni spesso simboleggiava le speranze e le ambizioni del periodo, usando suoni che non erano tradizionalmente considerati musicali per creare atmosfere uniche. Questo tipo di musica aiutava gli ascoltatori a vedere il mondo in modi nuovi, proprio come le invenzioni e le strutture esposte durante gli eventi. Compositori come Debussy, con opere come "Prelude à l'après-midi d'un faune", mostravano come la musica potesse evocare un'atmosfera senza bisogno di parole o storie chiare, aprendo la strada a future esplorazioni musicali che continuano a influenzare i compositori anche oggi. In conclusione, le Esposizioni Universali della Belle Époque non solo mostrarono al mondo nuove tecnologie e idee, ma furono anche fondamentali per lo sviluppo di nuovi stili musicali che cercavano di esprimere pensieri e sentimenti profondi attraverso suoni innovativi e evocativi.

Create a reading comprehension quiz based on the following text: Not many people 'have heard/ heard of Nikola Tesla, who 2played/was playing a key role in creating the alternating current (AC) supply of electricity we are having/ have in our homes today. Early in his career, Tesla has worked / worked with Thomas Edison. He had emigrated/ has emigrated to the USA from Europe in 1884. While Tesla was working/ had worked for Edison, they had an argument over payment for an invention, so Tesla was deciding/ decided to work independently. It was then that he developed a motor that could produce an alternating current. Throughout his life, Tesla continued to conduct experiments and helped / was helping develop X-ray radiography and wireless communication. There is no doubt that he has had / had had a large impact on modern technology. Many of the gadgets that we 10 are enjoying/enjoy today would not have been possible without Nikola Tesla.

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.

Short Quiz in Science 10 explain the operation of a simple electric motor and generator

Lide 1: Introduction to Bioreactor A bioreactor is a vessel used for growing microorganisms, plant or animal cells Provides controlled conditions for biological reactions Maintains optimum pH, temperature, oxygen, and nutrients Widely used in fermentation, enzyme, vaccine, and antibiotic production Ensures sterile and aseptic environment Scale ranges from laboratory to industrial production Slide 2: Basic Design Requirements of a Bioreactor Must be constructed with non-toxic, corrosion-resistant materials Should allow effective mixing and mass transfer Provision for sterilization (in situ sterilization) Must maintain uniform temperature and pH Easy sampling without contamination Should support scalability and automation Slide 3: Materials Used in Bioreactor Construction Stainless steel (SS-316) for industrial bioreactors Glass for laboratory-scale bioreactors Plastic (polycarbonate) for disposable bioreactors Materials must withstand heat and pressure Should be smooth to prevent microbial attachment Resistant to chemicals and cleaning agents Slide 4: Main Parts of a Bioreactor Vessel: holds the culture medium and microorganisms Agitator (impeller): provides mixing Sparger: supplies sterile air Baffles: prevent vortex formation Sensors: monitor pH, temperature, dissolved oxygen Ports: used for inoculation, sampling, and feeding Slide 5: Agitation System Ensures uniform mixing of nutrients and cells Improves oxygen transfer rate Common impellers: Rushton turbine, marine propeller Speed controlled by motor Prevents settling of cells Affects shear stress on cells Slide 6: Aeration System Supplies oxygen for aerobic fermentation Air introduced through sparger Types of spargers: ring, nozzle, sintered Maintains dissolved oxygen concentration Air is filtered for sterility Essential for high cell density cultures Slide 7: Temperature and pH Control Temperature controlled by heating/cooling jackets pH maintained using acid or alkali addition Sensors continuously monitor parameters Automated control systems used Ensures optimal microbial growth Prevents enzyme denaturation Slide 8: Foam Control System Foam formed due to protein and agitation Excess foam reduces oxygen transfer Mechanical foam breakers used Chemical antifoam agents added Foam sensor detects foam formation Maintains efficient fermentation Slide 9: Types of Bioreactors – Based on Mode of Operation Batch bioreactor Fed-batch bioreactor Continuous bioreactor Choice depends on product type Widely used in industrial fermentation Controls productivity and yield Slide 10: Batch Bioreactor All nutrients added at the beginning No addition or removal during process Simple and easy to operate Low risk of contamination Used for antibiotics and enzymes Limited control over nutrient depletion Slide 11: Fed-Batch Bioreactor Nutrients added during fermentation Prevents substrate inhibition High product yield Widely used in industrial fermentation Allows better control of growth rate Used in insulin and enzyme production Slide 12: Continuous Bioreactor Fresh medium continuously added Culture removed at same rate Maintains steady-state conditions High productivity Risk of contamination is high Used in wastewater treatment and SCP production Slide 13: Types of Bioreactors – Based on Design Stirred tank bioreactor Airlift bioreactor Bubble column bioreactor Packed bed bioreactor Fluidized bed bioreactor Photobioreactor Slide 14: Stirred Tank Bioreactor (STR) Most commonly used bioreactor Mechanical agitation using impellers Suitable for aerobic fermentation Excellent mixing and oxygen transfer Used for bacteria and fungi Easy scale-up Slide 15: Airlift Bioreactor Mixing achieved by air circulation No mechanical agitator Low shear stress Energy efficient Suitable for shear-sensitive cells Used in wastewater treatment Slide 16: Bubble Column Bioreactor Air bubbles provide mixing Simple design and low cost No moving parts Limited mixing efficiency Used for microbial fermentation Suitable for large-scale operations Slide 17: Packed Bed Bioreactor Contains immobilized cells or enzymes Substrate flows through packed matrix High cell density Used in continuous processes Limited oxygen transfer Used in enzyme and wastewater treatment Slide 18: Fluidized Bed Bioreactor Immobilized particles kept in suspension Better mass transfer than packed bed Reduced clogging Suitable for continuous operation Used in biotransformations Higher operational complexity Slide 19: Photobioreactor Designed for photosynthetic organisms Provides light source Used for algae and cyanobacteria Controls light, CO₂, and temperature Used in biofuel and pigment production Can be tubular or flat-plate design Slide 20: Applications of Bioreactors Production of antibiotics and vaccines Enzyme and organic acid production Single cell protein production Wastewater treatment Biofertilizer and biopesticide production Biopharmaceutical manufacturing

Multiple choice quiz on this reading: By 1900, the United States had claimed its place as a world power through the Spanish-American War. As the new century began, the country governed subject territories in Puerto Rico, Hawaii, Guam, the Wake Islands, and the Philippines. U.S. troops also occupied Cuba. U.S. businesses reached beyond the country's borders. During the first decade of the new century, the Coca-Cola Company, Quaker Oats, AT&T, the Standard Oil Company, Du Pont, General Electric, and Ford Motor Company seized the opportunity for international sales. After finding international markets, they built factories abroad, taking advantage of lower labor costs in foreign countries. Then they asked for U.S. protection of their investments and interests. Foreign countries invested heavily in Central America. U.S. investors focused on banana plantations and mining, as well as railroads, with little money in government bonds. By 1913, U.S. investments in Central America totaled about $93 million. British investment in Central America peaked at about $115 million in 1913. About $75 million of that total represented railroad holdings, mostly in Costa Rica and Guatemala. The other $40 million was in government bonds, which were worth little or nothing. The Roosevelt Corollary to the Monroe Doctrine From its earliest days, the United States claimed a special interest in the Western Hemisphere. The Monroe Doctrine, issued in 1823, warned European powers to keep their hands off Latin America. In 1902, Britain, Germany, and Italy mounted a naval blockade of Venezuela. They wanted to force the government to repay its debts. All the countries involved eventually agreed to settle the matter by arbitration. The United States stood back and did nothing, but U.S. citizens were clearly uneasy with the appearance of European military forces in "their" hemisphere. In 1904, President Theodore Roosevelt issued a corollary to the Monroe Doctrine, saying that the United States would act as a police officer to keep order in the region. He intended both to keep European military forces out of the hemisphere and to protect U.S. and European investors, exerting whatever pressure or control on Latin American governments that might be necessary to these ends. In 1905, the Dominican Republic owed $40 million in debts to European lenders. In order to prevent the European nations from using military force to collect their debts, Roosevelt used U.S. power. The United States basically took over collection of Dominican customs taxes, declared that $20 million of the debt was unjustified, and began repayment of the rest. Building a Canal The United States needed a canal through Central America, in order to save shipping time and costs. Colombia had the best location for a canal, and the United States negotiated a deal. It would pay Colombia $10 million for a three-mile-wide strip of land and would make annual rental payments of $250,000 yearly, beginning in 1912. Colombia's Senate turned down the deal, and Roosevelt exploded in rage, calling its members "foolish and homicidal corruptionists." Roosevelt considered seizing the land for the canal by military force but soon found an easier way. The province of Panama seceded from Colombia. A U.S. gunship stood off shore, protecting the Panamanian rebels. They formed a new republic under the protection of the United States. The new country of Panama and the United States agreed on a canal treaty within days. The new treaty had similar terms except that the Canal Zone would be five miles wide, instead of three, and the United States would guarantee and maintain the independence of Panama. Revolutions While Roosevelt welcomed the revolution that separated Panama from Colombia, he opposed most other revolutionary activity. So did his successors in office, William Howard Taft and Woodrow Wilson. The U.S. presidents sent troops to put down revolutions in Nicaragua and Haiti, using U.S. military forces to set up new governments in those countries and maintaining military occupations for years. U.S. military interventions were frequent throughout the hemisphere. Dollar Diplomacy President Taft preferred using "dollar diplomacy" to control Latin American countries. In Honduras, for example, U.S.-based banana companies virtually ran the government. Taft supported expanded U.S. investment in South and Central American countries, the Caribbean, and the Far East. He ordered Secretary of State Philander Chase Knox to protect U.S. investments, sending in military troops if necessary. On the World Stage As a world power, the United States did not limit its involvement to the Western Hemisphere. In 1905, President Roosevelt brought Russia and Japan to the negotiating table to end their war over control of Korea and Manchuria. Roosevelt agreed to Japanese annexation of Korea in return for Japan giving up any claim to China, Hawaii, and the Philippines. Roosevelt won the Nobel Peace Prize for settling this dispute. In 1906, Roosevelt's negotiating powers were tested again. This time, he mediated a dispute between the Alliance powers—Germany, Austria-Hungary, and Italy—with the Entente—France, Russia, and Britain—over control of Morocco. The United States backed France and ended the dispute. No longer an upstart, the United States had taken its place as a world power alongside its former colonial ruler.

The Invention of the Automobile An automobile, or car, is a wheeled vehicle that carries its own motor and transports passengers. The automobile as we know it was not invented in a single day by a single inventor. In 1769, the French engineer Nicolas-Joseph Cagnon devised the first self-propelled road vehicle, a military tractor powered by a steam engine. One year later, Cagnon built a steam-driven tricycle that could carry four passengers, but steam engines were very heavy and they proved a poor design for road vehicles. Around 1830, the Scotsman Robert Anderson built the first electric carriage. Both steam and electric road vehicles were soon abandoned in favour of petrol-powered vehicles. In 1876, Nicolaus August Otto built the first practical four-stroke internal combustion engine. In an internal combustion engine, the fuel is burnt inside the engine, while in a steam engine, the fuel is burnt outside. The most common internal combustion engine type is petrol-powered. The first petrol-powered vehicles were developed by Gottlieb Daimler and Karl Benz. In 1885, Karl Benz designed the first three-wheeler powered by an internal combustion engine. In 1891, Benz built the first four-wheeler. The first automobile to be mass-produced in the USA was the 1901 curved-dashed Oldsmobile built by Ransom L.E. Odds. Odds devised the basic concept of the assembly line and started the Detroit-area automobile industry. Henry Ford installed the first conveyor belt-based assembly line in his car factory in Michigan in 1913. The assembly line reduced production costs for cars by reducing assembling time. Ford's famous Model T was assembled in 93 minutes. The Ford Motor Company was launched in 1903, and by 1927, 15 million Model Ts have been manufactured. The modern era of automobiles had begun. The assembly line During the period known as the Industrial Revolution (1760-1850) machines changed people’s lives as well as their methods of manufacturing. Most products people in the industrialized nations use today are manufactured by the process of mass production, that is by people and robots that use power-driven machines. Through the use of mass pro-duction methods and the assembly line, a larger amount of goods can be produced in a given period of time, usually at a lower cost.The assembly line developed at the Ford Motor Com-pany in 1913 had immense influence on the automo-tive industry and on other industrial branches. Henry Ford, founder of the company, had built his first car in 1896 and was unique among automobile inventors. In Ford’s early assembly line, cars were pulled by rope from one worker to the next. This new technique allowed individual workers to stay in one place and perform the same task repeatedly on vehi-cles as they passed by. This reduced production timeby about one-half. Ford later employed the use of conveyor belts to move the parts down the line.

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

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