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Search for the perfect Sandwich, part 3
Quiz by Greg Williford
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What was Ana wearing to start her search on Monday?
Where did Ana go for her sandwich on Tuesday?
What was Ana wearing to start her search on Monday?
Where did Ana go for her sandwich on Tuesday?
What did Ana put in her sandwich on Wednesday?
What clothes did Ana wear for her meeting on Thursday?
What did Ana do after her workout on Friday?
How did Ana dress for her day at the beach on Saturday?
What was Ana's Sunday activity, and what was she wearing?
What did Ana wear to explore on Wednesday?
How did Ana dress for the hot weather on Monday?
How did Ana prepare for the beach on Saturday?
What did Ana have for breakfast on Sunday?
What sports clothes did Ana wear on Friday?
What did Ana wear for the Thursday meeting?
What did Ana eat after exercising on Friday?
Where did Ana eat on Saturday?
Search for the perfect sandwich , part 2The Search for the Perfect sandwhich, Quiz 1Alright, Isti — here’s a longer and more detailed English version of the Isaac Newton text, still written at a level that’s accessible for Grade 4 students, but rich enough in information to meet PISA literacy expectations and EF A2-level vocabulary. I’ve kept sentences short, clear, and with explanations for new concepts so it’s easier for young learners to follow, while still including both famous facts and lesser-known stories. ⸻ Isaac Newton: The Man Who Changed the Way We See the World A Boy from a Small Village Isaac Newton was born on January 4, 1643, in Woolsthorpe, a small village in England. His life was not easy. His father died before he was born. When he was just a few months old, his mother remarried and left him to live with his grandmother. Isaac missed his parents, but he kept himself busy by making things and exploring the world around him. As a child, Isaac liked to build models and machines. He made a small windmill that could turn with the wind. He built a water clock that told the time by dripping water into a container. He even made a sundial — a clock that tells the time by using the shadow of the sun. 💡 Did you know? The sundial marks that Isaac carved as a boy can still be seen today on the wall of his old house. ⸻ School and Curiosity When Newton first went to school, he was not the top student. At first, he did not pay much attention in class. But one day, another boy teased him for not being smart. Newton decided to study hard to prove him wrong. Soon, he became the best in his class. Isaac loved asking questions. He wanted to know how and why things happened. He enjoyed watching the stars at night and thinking about how the world worked. ⸻ The Falling Apple and Gravity One of the most famous stories about Newton is the falling apple. One afternoon, Isaac sat in his mother’s garden and saw an apple drop from a tree. This made him think: “Why does the apple fall straight down? Why doesn’t it fly up into the sky?” From this question, Newton began to think about gravity — an invisible force that pulls objects toward each other. Gravity is what keeps our feet on the ground. It’s also what keeps the Moon moving around the Earth and the planets moving around the Sun. 💡 Fun fact: The apple did not hit Newton’s head. That’s just a story people made up later to make the tale more exciting. ⸻ Newton’s Three Laws of Motion Newton studied movement and wrote three important rules: 1. Objects stay still or keep moving unless something makes them change. • Example: A ball will not roll unless you push it. 2. The bigger the push, the bigger the movement. • Example: If you kick a ball harder, it will go faster and farther. 3. Every action has an equal and opposite reaction. • Example: When you jump off a boat, the boat moves backward as you move forward. These three laws are still used today to understand how cars, rockets, and even roller coasters work. ⸻ Discoveries in Light and Color Newton also studied light. He found that white light is not just one color — it is made of many colors. He used a glass prism to split sunlight into a rainbow. This helped scientists understand how colors work. ⸻ Inventions and New Ideas Newton made a special telescope that used mirrors instead of lenses. This type of telescope made images of planets and stars much clearer. It is still called the Newtonian telescope today. He also worked in mathematics and helped create a new type of math called calculus, which is used to study changes and movement. ⸻ Strange Experiments Newton was so curious that he sometimes tested ideas on himself. Once, he put a thin needle, called a bodkin, beside his eye to see how it would change his vision. It was very dangerous, but luckily he did not go blind. 💡 Did you know? Newton also studied alchemy — an old kind of science where people tried to turn metal into gold. He never succeeded, but it showed how wide his interests were. ⸻ Later Life and Work At the age of 27, Newton became a professor at Cambridge University. He later worked for the Royal Mint, making sure coins were made safely and stopping people from making fake money. He was very strict, and some criminals were sent to prison because of his work. Newton never married. He spent most of his life reading, writing, and doing experiments. ⸻ The End of His Life Isaac Newton died in 1727 at the age of 84. He was buried in Westminster Abbey, a famous place in London where great people of Britain are honored. His work changed the world forever. Even today, scientists, engineers, and students still use Newton’s laws and ideas. 💬 Newton once said: “If I have seen further, it is by standing on the shoulders of giants.” This means we can make new discoveries by learning from the work of others who came before us. give 10 questions to each passage with PISA literacy standard for kid 10 years, 1. Nikola Tesla: The Man Who Dreamed of Lightning Born: July 10, 1856 Died: January 7, 1943 When Nikola Tesla was a boy in Croatia, he saw a flash of lightning and asked his mother, “Can we catch the light?” That question never left him. As he grew older, Tesla became a brilliant inventor, especially fascinated by electricity. He believed in a future where energy could be sent wirelessly through the air—like music through the radio! Tesla invented the alternating current (AC) system, which became the foundation of modern electricity. At the time, Thomas Edison promoted direct current (DC), and the two men had a fierce competition. Many laughed at Tesla's bold ideas, but he never gave up. He dreamed of wireless communication, flying machines, and even free energy for everyone. Though he died alone and poor, today the world honors his vision. Think About It: Why do you think people didn’t believe Tesla at first? What can we learn from Tesla’s courage to dream big? 2. Charles Darwin: The Man Who Studied the World’s Weirdest Creatures Born: February 12, 1809 Died: April 19, 1882 When young Charles Darwin got on a ship called HMS Beagle, he didn’t know he would change science forever. He sailed around the world for five years, collecting plants, animals, and fossils. On the Galápagos Islands, he noticed something curious: finches had different beaks depending on their island. Why? Darwin’s observations led him to write the theory of evolution by natural selection. It explained how animals adapt and survive. But his ideas shocked many people because they seemed to challenge religious beliefs. Despite the controversy, Darwin continued his work. His book On the Origin of Species changed how we see life on Earth. Think About It: Should scientists share their ideas even if they go against what others believe? How did traveling help Darwin make new discoveries? 3. Marie Curie: The Woman Who Glowed in the Dark Born: November 7, 1867 Died: July 4, 1934 Marie Curie was born in Poland at a time when girls were not allowed to study science. But that didn’t stop her. She moved to France, worked day and night, and discovered radioactivity, a powerful energy hidden inside atoms. She and her husband, Pierre Curie, found two new elements: polonium and radium. She became the first woman to win a Nobel Prize, and the only person to win in two different sciences: physics and chemistry. Even when Pierre died in an accident, Marie continued their work. Her discoveries helped doctors treat cancer—but working with radioactive materials also harmed her health. She died from radiation exposure, but her legacy lives on. Think About It: What challenges did Marie Curie face as a woman in science? Why is it important to balance discovery with safety? 4. Galileo Galilei: The Star Watcher Who Defied the Church Born: February 15, 1564 Died: January 8, 1642 Galileo loved looking at the stars. He built one of the first powerful telescopes and made stunning discoveries: mountains on the Moon, moons around Jupiter, and that the Earth orbits the Sun—not the other way around. This idea, called heliocentrism, went against the teachings of the Church. He was put on trial and forced to say he was wrong. But he wasn’t. He spent his last years under house arrest, quietly writing. Today, Galileo is called the father of modern science for daring to question what others blindly believed. Think About It: Why do you think Galileo was punished for telling the truth? Should science always follow evidence, even if it goes against powerful beliefs? 5. Isaac Newton: The Man Who Asked “Why?” When an Apple Fell Born: January 4, 1643 Died: March 31, 1727 One day, an apple fell from a tree, and Isaac Newton began to wonder: Why did it fall down, not sideways or up? This simple question led to his theory of gravity. Newton also invented calculus, described the laws of motion, and changed physics forever. But Newton wasn’t just a genius—he was curious, quiet, and often worked alone. He believed everything in nature followed rules, and it was our job to discover them. Thanks to him, we understand how planets move, how rockets launch, and why you fall when you trip. Think About It: How did Newton’s curiosity lead to great discoveries? Do you think working alone helped or hurt Newton? 6. Ada Lovelace: The First Computer Programmer Before Computers Existed Born: December 10, 1815 Died: November 27, 1852 Ada Lovelace was the daughter of the famous poet Lord Byron, but she didn’t love poetry—she loved numbers! At a time when girls were expected to sew, Ada studied mathematics. She met Charles Babbage, who designed an early computer called the Analytical Engine. Ada imagined the machine could do more than just math—it could create music, art, and even write! She wrote what is now considered the first computer program, long before real computers were built. Think About It: How did Ada imagine something that didn’t exist yet? Why do we call her a pioneer in technology? 7. Albert Einstein: The Man Who Brought Time and Space Together Born: March 14, 1879 Died: April 18, 1955 Albert Einstein wasn’t always a good student. In fact, his teachers thought he was slow. But Einstein thought deeply. He asked big questions like, “What if you could ride a beam of light?” His theories of relativity changed how we see space, time, and gravity. He also warned the world about the dangers of nuclear weapons, even though his ideas helped create them. Einstein believed science should help people, not harm them. With his messy hair, kind smile, and brilliant mind, he remains a symbol of genius. Think About It: Can someone be bad in school but still be brilliant? Should scientists be responsible for how their inventions are used? 8. Pythagoras: The Musician Who Loved Math Born: Around 570 BC Died: Around 495 BC Long ago in ancient Greece, Pythagoras believed the universe followed numbers. He discovered the Pythagorean Theorem, a rule about triangles that helps us build houses, design computers, and navigate space. He also believed that music had math inside it—that certain notes made perfect harmony because of mathematical ratios. Pythagoras started a secret school and taught his students to search for truth through numbers, shapes, and sound. Think About It: Why do you think Pythagoras saw math in everything? How does music relate to math? 9. Rosalind Franklin: The Woman Behind the DNA Discovery Born: July 25, 1920 Died: April 16, 1958 Rosalind Franklin loved looking closely at things. She used a special machine called X-ray crystallography to photograph molecules. One of her greatest photos, called Photo 51, showed the shape of DNA, the molecule that carries life’s instructions. But her work was taken without credit. Two men, Watson and Crick, used her photo to build their famous model of DNA and won the Nobel Prize. Rosalind died young and never knew how important her work became. Think About It: Why is it important to give credit in science? What can we learn from Rosalind’s quiet strength? 10. Carl Linnaeus: The Man Who Gave Names to Everything Born: May 23, 1707 Died: January 10, 1778 Have you ever wondered why a tiger is called Panthera tigris? That’s thanks to Carl Linnaeus, a Swedish scientist who created a way to name and organize every living thing. His system is still used today in biology. Linnaeus loved nature and spent his life collecting plants, animals, and even rocks. He believed that by organizing life, we could better understand it. Thanks to him, we now have a global “dictionary of nature.” Think About It: Why is it important to name and organize living things? How does order help us understand the world?If we look at the United States on a map today, it is very difficult to imagine that where we see borders, cities, and states, there once existed nothing but open land, uncharted mountain ranges, and miles of untouched wilderness. North America was a highly desired destination for exploration and settlement for Europeans. In the early 1500s, expeditions from Europe to North America were funded by Europe's kings and queens in hopes of expanding their territories across the world. The voyages were treacherous with unknown dangers and many attempts to settle in this new land were faced with failure. In the early 1600’s however, the settlers of Jamestown and Plymouth survived the harsh conditions and established the first two permanent English settlements in North America. Jamestown Colony in Virginia Jamestown was founded in 1607. Of course, its colonists did not know it would go on to become the the first permanent English settlement in the Americas. The settlement was located along the James River off Chesapeake Bay in modern-day Virginia. Life in Jamestown was very hard, and nearly 80% of the first settlers died in the first year due to disease and starvation. The region was warm and had fertile soil, making it a perfect place for growing crops, specifically tobacco. Sponsored by a joint stock company known as the Virginia Company of London, Jamestown was originally established as a profit-making enterprise. The first settlers looked for gold and other natural resources that could bring a profit to the company's investors. After several very difficult years, the colonists were eventually able to grow tobacco that was popular in England and it became a valuable cash crop. Jamestown's colonists were primarily all supporters of the Church of England and felt a strong connection to their homeland. Many, like John Smith, returned to England, or would move back and forth between the two locations. Being that Jamestown was founded by a corporation looking to make a profit, it began using enslaved labor in 1619. Indentured servants and enslaved Africans made up much of the workforce on the growing tobacco and cotton plantations. The system of using enslaved Africans for the profit of American plantations has been described as America's "original sin". About 400 miles to the north of Jamestown, a group of Pilgrims seeking religious freedom established Plymouth in 1620 as the second English colony in North America. Located in modern day Massachusetts, the colder climate and rocky soil made farming and agriculture more difficult. Instead of growing cash crops, settlers turned to lumber, shipbuilding, and fishing for trade. Unlike the settlers of Jamestown, the Pilgrims of Plymouth Colony were dissenters from the Church of England. They came to the New World so that they could freely practice their religion without fear of persecution. Although their reasons for settling were different, the settlements had many similar experiences. Jamestown and Plymouth both faced harsh and demanding climates and struggled with hunger, disease, and death. In their first years they had much difficulty establishing housing and finding a sustainable source of food. Plymouth Colony in New England While the settlers in Jamestown used the House of Burgesses as a legislative body for laws and decisions, the Pilgrims in Plymouth wrote and agreed to the Mayflower Compact as a set of rules for self-government. Both helped maintain the rule of law in new places far from the courts and tradition of England. Settlers of both colonies experienced complicated and, at times, violent relationships with local Native Americans that owned the land. While some American Indian groups offered help to the new settlers, oftentimes both sides needed to defend themselves from attacks. Nevertheless, the settlers of Jamestown and Plymouth persevered through these difficulties and maintained their establishments, providing inspiration for future colonies and settlers in search of a new life in the New World.Search for the ShadowmanPhrasal Verb Quiz Instructions: Choose the best meaning for the bold phrasal verb in each sentence. She looked up a word in the dictionary. A) To stare at something B) To find information in a book or online C) To write a new word She looked up at the sky. A) To raise your eyes to see something above B) To search for a specific star C) To feel happy He always tries to get out of doing his chores. A) To leave the house B) To finish work quickly C) To avoid doing something you don't want to do Why didn’t you call me back last night? A) To shout at someone B) To return a phone call C) To remember a name She was bored at the party, so she took off. A) To start dancing B) To leave suddenly C) To remove her coat I can’t figure out the answer to this question. A) To understand or solve something B) To draw a picture C) To forget a fact I am free on Sunday. Do you want to come over? A) To go to a store B) To visit someone’s house C) To call someone on the phone He had to make up a story about a dragon and a princess. A) To read a book aloud B) To invent or create a story C) To fix a mistake After three years in college, she suddenly dropped out. A) To graduate with honors B) To stop attending school before finishing C) To fall down the stairs My manager handed out the reports during the meeting. A) To give something to many people in a group B) To throw something away C) To write a report by hand I had to fill out a form. A) To complete a document by writing information B) To make something bigger C) To throw a paper in the trash I ran into some old friends yesterday. A) To race against someone B) To meet someone by chance (unexpectedly) C) To call someone on purpose We will pick up our parents from the airport tonight. A) To lift something heavy B) To collect someone in a car C) To say goodbye When are you going to give up smoking? A) To start a new habit B) To stop doing something C) To buy something expensive My teacher crossed out my mistakes with a red pen. A) To draw a line through something B) To highlight something important C) To give a good grade I should go over my notes before my presentation. A) To lose your papers B) To review or check something carefully C) To write new notesTitle: The Adventures of Max and the Magical Computer (Shortened Version) Once upon a time, in a small town called Techville, there lived a curious fourth-grader named Max. One day, while exploring his grandma’s attic, he found an old, dusty computer. As he cleaned it, the screen lit up, and a cheerful voice said, “Hello, Max! I’m Compy, your magical computer. Let’s learn about operating systems, files, and folders!” Max was thrilled. “A talking computer? Let’s go!” Chapter 1: The World of Windows Compy explained, “I run on Windows, the brain of the computer. It uses a Graphical User Interface (GUI), so you can interact with me using icons, menus, and buttons. Let’s start by changing my desktop background—the image on the screen.” Max chose a spaceship picture. “Cool! Can I add a screen saver too?” “Of course!” said Compy. “It’s an image that appears when I’m inactive. Try this swirling galaxy!” Max set the screen saver and giggled as it appeared. “This is fun!” Chapter 2: Organizing with Folders and Files Compy’s screen filled with random icons. “Oh no! My files are a mess. Can you help?” “Sure! What are files and folders?” asked Max. “A file is information, like a picture or document. Files have names, like ‘Homework.docx.’ The part after the dot, like .docx, is the file extension. It tells you the file type,” Compy explained. Max pointed to “Game.exe.” “So, this is a program file?” “Yes!” said Compy. “To organize, we use folders—like drawers for files. You can even put folders inside folders!” Max created a “School” folder, added his homework files, and made a “Projects” folder inside it. “Now everything’s neat!” Chapter 3: The File Explorer Adventure Compy’s screen flickered. “Some files are missing. Let’s use Windows Explorer to find them. It’s like a map for files and folders.” Max opened Windows Explorer and saw a tree-like list of folders. “This is like a tree with branches!” “Exactly!” said Compy. “Search for the missing files and move them to the right folders.” Max found the files in “Downloads” and moved them. “I feel like a computer detective!” Chapter 4: The Final Challenge Compy’s screen turned into a game board. “Time for a quiz! What’s the purpose of an operating system? How do you change the desktop background? What’s the difference between a file and a folder?” Max answered all the questions correctly, and fireworks lit up the screen. “Congratulations, Max! You’re a computer whiz!” The End Max smiled. “Thanks, Compy! I can’t wait to teach my friends!” Compy replied, “Remember, Max, learning is an adventure. Keep exploring!” As Max turned off the computer, he knew his journey into technology had just begun. [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.