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Akali's Item Build:
Hextech Revolver, turned into a Gunblade
Rylai's Crystal Scepter
Why Doran's Blade? You'll activate your spell vamp discipline and gain lifesteal. Those who stack AP/AD runes only benefit at level, but drop behind after even a few levels, due to lack of potency.
You want Magic Pen in every slot and ability power in the slots you cannot fill. Doran's Blade activates your spell vamp, which is all you need at level 1. Your self heal, combined with lifesteal, will allow you to regain health faster than most champions, even at level 1. Do not set up a special rune page just for Akali. It isn't necessary and hinders you after about 5-8 minutes into the game.
21/0/9, picking up the +damage talents and one in ignite. Your rune sets should give you at least 6 AP and with the ignite, you should activate your twin discipline within a few levels, without AP items.
Flash/Ignite. No compromise. You absolutely want ignite on Akali. The ability to burst a player down and following through with an ignite ensures kill after kill. The ability for you to flash and ult at a player, means you can keep a hefty distance from someone and drop on them in an instant.
You want to prioritize Q first, getting it at 1/3/5/7/9. You'll get one rank of W at 2, and one rank of E at 4. After Q/R is maxed, you'll focus on E second. You can level up your stealth pool last. One rank is effective.
How to play:
Akali is versatile in any lane. She is great in mid, solo top or duo lane bottom. I recommend a duo lane until you've mastered her. Using her Q, you can harass players on a very short cooldown. If they want to exchange blows, your damage is very devastating, even at level 1. If you can get away with it, keep poking them with your Q. If they want to get into melee range, activate the on-hit effect of the Q and walk away. Depending on your timing, you can get a "double dip" on the Q, which means that your Q is off cooldown and the "proc" is still on the player. You would then auto-attack the player, hit them with Q and auto-attack them again. This double dip combo is very devastating and you should take advantage of it as much as possible.
Once you hit level two, the harassment increases significantly. You can box players out and force them to take significant damage, without retribution. Toss a stealth bubble in their creep wave. At this point, you harass opponents that are near. They'll realize quickly that their mana-based harass is doing little against your spell vamp/lifesteal and they'll go OOM quickly. Meanwhile, your energy based harass never runs out. They'll quickly learn to leave you alone. Eventually, you can box them out. If they stand too far back, use your Q to finish off minions. At level 1, you can Q + Auto attack to ensure a last hit. Once you get a third rank of Q (Level 5), you can begin insta-gibbing caster minions with that combo. In mid-game, when you finish Lich Bane, you should be able to insta-gib melee minions as well.
Use your ability to harass to safely farm. Don't spend so much time harassing that you miss out on minion kills. You'll get very few early level kills, due to your lack of sustained damage. Only when a champion sticks through with a battle to the end, will they die.
Once you hit level 6, you then have the ability to gank and kill. You generally have only your boots by level 6, making you very fast versus other champs who pick up +2 boots, or get a different starter item. Fortunately, Akali is not as item dependant as others.
Smart Casting: Akali smart casting is absolutely required. Properly comboing her is the way to victory. At level 6, her harass turns into possible kills. Use her Q to initiate and follow up with an R to the face. Land an auto-attack and proc your Q. Against most champions, this is at least half their health. Having stored 3 stacks of your ult, you should be able to kill many champions at that point, landing another Q and ult-combo-ing again. By holding down Shift and mousing over an opponent, you can spam your abilities on them and latch on them hard. Akali needs this to survive. You cannot manually shoot off her abilities at the rate required.
Harassing champs with Crowd Control: So you're up against a fiddle who fears you as soon as you fly into him, while he proceeds to drain you. Neither of you get very far and your down more than he is. How do you fix this? Smart casting. Mouse over that CC'ing champ, holding down shift and spam the R/W buttons. By doing this, you will fly at that champ and immediately toss down a stealth bubble on top of them. While they arrogantly try to wait for you to be CC'd, hit them with a Q and an auto. By now, they should realize that they're in bad shape. If they stay in the stealth bubble, wait for your Q to come off cooldown and hit them again. At some point, they'll consider fleeing. You should still have 2 charges of your ult left (with at third on the way). This is where you'll want to burst the champ down. Ignite, Q spam, and ult spam and finish the champ off. If you've got extra energy, use E as well.
Countering players with oracles: Some players think they're smart and get oracles. Like you give a shit. You're a chaser and an assassin, very rarely using that bubble. By the time someone gets oracles, it's because you're fed and you don't need that bubble. At that point, you're using that bubble to slow enemy champs who may be chasing you as you escape after another gank. Buying oracles against an Akali only works against Akalis who weren't doing well to begin with.
Akali is not an initiator: You're not the tank. You're the clean-up. In fact, you'll be focused so hard that you'll not actually enter a team fight until the opposite team is fully engaged with your team. If you're smart, you'll try to hide in a bush at the enemy flank. Your job is to fly and and take out their carries in the back. Since you have flash, you should have no problems flashing/ulting across the enemy field to burst.
Learn to use your Hextech: Put your Hextech Gunblade in the first item slot. Get used to using its on use ability. Not only does it have an awesome slow (which is a good filler until you get Rylai's), but it does 300 damage as well, allowing for an additional burst. Comboing can be brutal for Akali, but you need to use it. Hit them with an Q/R and once you're close, hit them with the Gunblade on-use ability. By putting it in the first item slot, you can use the "1" key to activate it. Gunblade, Q, R, E, Ignite, Lich Bane procs, with repeated Q/R follow-ups means nobody is surviving.
Item build never varies: Never. Do not swap for survivability. You cannot play as a partial tank. You need to assassinate, or never engage. If you're having problems picking people off, hide over in their jungle. Some carry will sneak up to their blue and you should be able to instagib them if they come up.
You will suck with Akali your first time: You will do horribly your first game with Akali. That's fine. Akali is a champion that takes several games of practice to understand. Do not get discouraged. Play her again and again until you figure her out and you will find she was one of the best carries in the game.
Akali is an amazing killer, but a poor pusher: You need a team to take advantage of your ability to annihilate the enemy team. When it comes time to pushing towers, Akali isn't the best at hitting towers, since she's AP based. You can, however, get decent hits on an enemy tower once you get Lich Bane. Lich Bane procs on abilities, so use your E on the tower. The E does 0 damage, but you'll proc the Lich Bane and that full damage hits a tower.
End-game build is devastating: If you're allowed to actually accumulate all six items, you will be absolutely devastating. Not only can you go toe to toe with any champ, you'll be capable of bursting down the squishy champions in under one second. I've dropped champions like Twisted Fate or Heimerdinger at level 18 with this build in one R/Q combo.