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"The aim of this book is to provide insight into the principles of operation of the cerebral cortex. These principles are key to understanding how we, as humans, function. There have been few previous attempts to set out some of the important principles of operation of the cortex, and this book is pioneering. The book goes beyond separate connectional neuroanatomical, neurophysiological, neuroimaging, neuropsychiatric, and computational neuroscience approaches, by combining evidence from all these areas to formulate hypotheses about how and what the cerebral cortex computes. As clear hypotheses are needed in this most important area of 21st century science, how our brains work, I have formulated a set of hypotheses about the principles of cortical operation to guide thinking and future research. The book focusses on the principles of operation of the cerebral cortex, because at this time it is possible to propose and describe many principles, and many are likely to stand the test of time, and provide a foundation for further developments, even if some need to be changed. In this context, I have not attempted to produce an overall theory of operation of the cerebral cortex, because at this stage of our understanding, such a theory would be incorrect or incomplete. However, many of the principles described will provide the foundations for more complete theories of the operation of the cerebral cortex. This book is intended to provide a foundation for future understanding, and it is hoped that future work will develop and add to these principles of operation of the cerebral cortex. The book includes Appendices on the operation of many of the neuronal networks described in the book, together with simulation software written in Matlab."

"Otak merupakan salah satu organ yang rentan hipoksia. Hipoksia menyebabkan kerusakan neuron terutama pada neuron korteks serebrum. Hingga saat ini belum ada agen neuroproteksi yang direkomendasikan untuk stroke iskemik sehingga terapi adjuvan sangatlah perlu diteliti. Ekstrak etanol Acalypha indica (AI) dan Centella asiatica (CA) telah banyak diketahui mampu mencegah kerusakan sel akibat hipoksia melalui aktivitas antioksidan. Penelitian ini bertujuan untuk melihat kemampuan neuroproteksi kedua herbal berdasarkan gambaran histopatologi neuron korteks serebrum. Sampel yang digunakan sebanyak 30 tikus jantan Spraque-Dawley yang diinduksi hipoksia selama 7 hari dan dilanjutkan dengan pemberian sediaan uji. Pemberian kombinasi AI dan CA menggunakan 2 dosis berbeda yaitu AI 200 mg/kgBB + CA 150 mg/kgBB dan AI 250 mg/kgBB + CA 100 mg/kgBB. Pemberian tunggal CA diberikan dengan dosis 100 mg/kgBB. Pemeriksaan histopatologi dilakukan dengan menghitung rerata persentase sel normalnya. Hasil uji one way ANOVA tidak menunjukkan perbedaan bermakna pada rerata persentase sel normal antar kelompok (p=0,575). Namun, terjadi peningkatan rerata persentase sel neuron normal dibanding kontrol negatif dengan urutan peningkatan terbanyak sebagai berikut: hipoksia+kombinasi 2 (15,43%), hipoksia+kombinasi 1 (11,46%) dan hipoksia+tunggal 2 (3,3%). Dapat disimpulkan bahwa pemberian kombinasi AI dan CA memiliki kecenderungan memperbaiki kerusakan sel neuron pascahipoksia.

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The Brain is an organ that is vulnerable to hypoxia. Hypoxia induces neuronal cell death especially in cerebral cortex neuron. Until now, there are no neuroprotective agents that are recommended for ischemic stroke. Among all potential therapies, Acalypha indica (AI) and Centella asiatica (CA), are examples of promising herbs for preventing cell damage from hypoxia through their antioxidant activity. The research purpose was to show the neuroprotective capabilities of these herbs by examining their histopathological features. Thirty hypoxia-induced male Spraque-Dawley rats were given treatment that contain the combination of AI and CA (AI 200 mg/kgBW + CA 150 mg/kgBW and AI 250 mg/kgBW + CA 100 mg/kgBW) and a single CA 100 mg/kgBW. Through the histopathological examination, percentages of the normal cells were counted and analyzed. One way ANOVA was conducted and the results did not show a statistically significant difference between all of the groups (p=0.575). The quantitative results depict an increase in the percentage of normal neuron cells in all of the exposed groups compared to the negative control group: combination 2 (15,43%), combination 1 (11,46%) and single CA (3,3%), respectively. Thus, the combination of AI and CA treatment have a trend toward restoring the neuron damage."

"Hipoksia merupakan kondisi inadekuat suplai oksigen menyebabkan peningkatan radikal bebas perusak organ, contohnya otak. Radikal bebas dinetralisir antioksidan endogen dan eksogen. Acalypha indica dan Centella asiatica memiliki efek antioksidan. Pewarnaan AgNOR mengukur derajat kerusakan sel. Penelitian bertujuan membuktikan efek pemberian kombinasi ekstrak etanol akar Acalypha indica dan Centella asiatica pada histopatologi neuron korteks serebrum tikus pascahipoksia pewarnaan AgNOR. Penelitian mendapat sediaan dari 26 ekor tikus Spraque-Dawley, terbagi dalam 6 kelompok: kontrol normal; kontrol negatif (hipoksia+aquades); hipoksia+kombinasi 1; hipoksia+kombinasi 2; hipoksia+tunggal 2; kontrol positif (hipoksia+vit C). Induksi hipoksia selama 7 hari dengan mengalirkan O2 10% dan N2 90% bertekanan 1 atm. Setelah 7 hari, dilakukan Analisis Gas Darah, reoksigenasi 1 jam, dilanjutkan pemberian perlakuan aquades; (AI200+CA150); (AI250+CA100); CA150 dan vitamin C selama 7 hari. Pada akhir studi dilakukan euthanasia, organ otak diambil untuk pemeriksaan histopatologi dengan pewarnaan AgNOR. Hasil: Pemberian esktrak kombinasi 2, tunggal 2, dan kombinasi 1 berbeda bermakna dibandingkan kontrol negatif (p=0,000; p=0,005; p=0,023). Kesimpulan: Kombinasi ekstrak etanol (AI250+CA100) memiliki efek terbaik untuk mengurangi kerusakan neuron korteks serebrum secara histopatologi.

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Hypoxia is inadequate conditions of oxygen causes increasing free radicals destroying organs, e.g. brain. Free radicals neutralized by endogenous and exogenous antioxidants. Acalypha indica and Centella asiatica have antioxidant effects. AgNOR staining measures degree of damaged cell. The aim of this study was to prove the effect of the combination of ethanol extract on the roots of Acalypha indica and Centella asiatica on the histopathology of cortical neurons in cerebrum of rats after hypoxia in AgNOR staining. The study of 26 Spraque-Dawley rats, divided into 6 groups: normal control; negative control (hypoxia + aquades); hypoxia + combination 1; hypoxia + combination 2; hypoxia + single 2; positive control (hypoxia + vit C). Induction of hypoxia for 7 days by flowing 10% O2 and 90% N2 with 1 atm pressure. After 7 days, Blood Gas Analysis, 1 hour re-oxygenation, followed by treatments; distilled water; (AI200 + CA150); (AI250 + CA100); CA150 and vitamin C for 7 days. At the end of study, euthanasia was carried out, brain organs were taken for histopathology examination with AgNOR staining. The combination 2, single 2 and combination 1 extracts were significantly different compared to negative control (p = 0,000; p = 0.005; p = 0.023). The combination of ethanol extract (AI250 + CA100) has the best effect to reduce damage to cerebral cortical neurons histopathologically."

"Telah dilakukan penelitian mengenai tingkat kecerdasan pasien anak penyandang kelumpuhan otak (CP) di Yayasan pembinaan anak cacad (YPAC) Medan, dengan menghubungkan antara jenis CP, derajat retardasi mental, serta jenis kelamin. Penelitian dilaksanakan secara potong lintang, meliputi semua pasien dengan CP yang terdaftar dalam buku registrasi poliklinik YPAC Medan antara Juli 1987-Juni 1998. Semua di antara 74 pasien yang diikutsertakan dalam penelitian ini mempunyai IQ di bawah rata-rata dan 62% di antaranya berjenis perempuan. Jenis yang paling banyak ialah tipe spastik (65%), kemudian campuran (16%), diskinetik (11%) dan hipotonik (8%). Secara keseluruhan, golongan CP campuran mempunyai derajat retardasi mental paling berat. Secara statistik terdapat hubungan bermakna antara jenis CP dengan tingkat retardasi mental (P < 0.001), dan tak terdapat hubungan bermakna antara jenis CP dengan jenis kelamin. (Med J Indones 2002; 11: 242-5)

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Children with cerebral palsy has been investigated at YPAC (Yayasan Pembinaan Anak Cacat / Institute for Crippled Children) Medan to obtain the detailed description of patient?s intelligence level referring to cerebral palsy types and to determine the relationship between palsy types and mental retardation level as well as to relate cerebral palsy types and sex. The study is cross-sectionally conducted involving all cerebral palsy patients listed in registration book of YPAC Policlinic Medan from July 1987 to June 1998. Of 74 patients participated in the study, all had IQ under average and 62% them were female. The most common type is spastic (65%), followed by mixed (16%), dyskinetic (11%) and hypotonic (8%), respectively. Overall, the mixed type had severe mental retardation. Statistically, there is a significant relationship between cerebral palsy types and mental retardation level (p < 0.001). There is no significant relationship between cerebral palsy types and sex. (Med J Indones 2002; 11: 242-5)"

"Epilepsi merupakan suatu kondisi kronis yang disebabkan oleh gangguan fungsi otak. Keadaan ini merupakan penyulit yang biasa ditemukan pada berbagai gangguan neurologis seperti kelumpuhan otak (cerebral palsy: CP) yang dapat mengakibatkan kerusakan otak lebih lanjut, terutama apabila disertai dengan serangan kejang yang berlangsung lama. Insidens epilepsi pada penyandang CP berkisar antara 25 ? 35%. Insidens epilepsi yang sering pada pasien penyandang CP menunjukkan bahwa kedua kelainan tersebut agaknya mempunyai penyebab yang sama atau saling berhubungan. Kami melaksanakan suatu studi retrospektif untuk menentukan apakah insidens epilepsi berbeda tergantung pada tipe CP. Data diambil dari rekam medik, meliputi: nama, jenis kelamin, paritas, usia ibu, penatalaksanaan pra, peri dan pasca lahir serta hasil rekaman EEG. Pengolahan data menggunakan uji statistik X2 pada P < 0,05. Didapatkan di antara 67 kasus dengan CP, 53 bertipe CP spastik, 13 kasus campuran dan 1 CP diskinetik. Lelaki 47,8%, Perempuan 52,2% dengan usia rerata 50,3 (SD 36,3) bulan. Pada 25 pasien dengan CP yang berhubungan dengan epilepsi ditemukan 72% dengan kejang umum, 20% dengan kejang parsial, dan 8% dengan spasme infantil. Insidens epilepsi ternyata menunjukkan perbedaan yang bermakna (P < 0,05) tergantung tipe CP dan usia kehamilan saat pasien dilahirkan. Disimpulkan bahwa insidens epilepsi pada pasien penyandang CP di YPAC medan ialah 37,3%, dan terdapat perbedaan bermakna sesuai tipe CP dan usia kehamilan saat pasien dilahirkan. (Med J Indones 2002; 11: 158-63)

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Epilepsy is a chronic condition due to cerebral function disorders. Epilepsy occurs as a common complication of many neurological disorders such as cerebral palsy (CP) that can cause further brain damage if especially they are accompanied with prolonged seizure. The incidence of epilepsy among patients with CP varies, 25-35%. The high incidence of epilepsy among patients with CP suggests that these disorders has common or related origins. We carried out a retrospective study to determine the incidence of epilepsy among patients with CP registered July 1988 to June 1998 in YPAC Medan and to determine whether the incidence of epilepsy was different according to type of CP. Data was compiled from medical records, including name, sex, parity, mothers age, prenatal, perinatal, and postnatal history, and EEG resuts. Data were analysed using statistical computer program and its significance was evaluated by chi square test at p < 0.05. There were 67 cases with CP, 53 cases spastic CP, 13 cases mixed CP and one case dyskinetic CP. Of the 67 cases CP, 47.8% were male, 52.2% female with the mean age of 50.3 (SD 36.9) months. There were 25 (37.3%) patients CP associated with epilepsy, 72% general seizures, 20% partial seizures, and 8% infantile spasm. The incidence of epilepsy was significantly different among patients with CP associated with the type of CP and gestational age, p < 0.05. We concluded that the incidence of epilepsy among patient with CP in YPAC Medan was 37.3% and showed significant difference in CP according to type and gestational age. (Med J Indones 2002; 11: 158-63)"

"Latar belakang. Cerebral palsy CP adalah penyakit neurologi yang menyebabkan disabilitas jangka panjang. GMFCS adalah pengklasifikasian CP yang sering digunakan klinisi untuk melihat keparahan dan perkembangan penyakit CP. Terdapat beberapa faktor yang mungkin dapat memengaruhi perubahan motorik kasar pasien CP seperti usia, jenis kelamin, usia gestasi, tipe CP berdasar topografi, riwayat asfiksia, gambaran radiologi, ukuran lingkar kepala, adanya gangguan penglihatan, gangguan pendengaran, epilepsi dan lama mederita CP. Tujuan. Mengetahui karakteristik klinis pasien CP, perubahan motorik kasar berdasar GMFCS serta faktor-faktor yang mempengaruhinya.Metode penelitian. Penelitian berupa cross-sectional untuk melihat perubahan motorik kasar berdasarkan GMFCS dan faktor yang memengaruhinya. Analisis yang dipakai untuk mengetahui hubungan adalah uji MacNemar dan kai kuadrat. Hasil penelitian. Kejadian CP lebih banyak pada anak laki-laki 61 , lahir matur 75 , tipe tetraplegi 66 , radiologi abnormal 83,3 , lingkar kepala abnormal 83 dan adanya epilepsi 61. Didapatkan perbaikan bermakna antara GMFCS saat awal diagnosis dibandingkan GMFCS saat ini p

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Background. Cerebral palsy CP is a neurological disease that causes long-term disability. GMFCS is a CP classifier that clinicians often use to see the severity and progression of CP. There are several factors that may affect the gross motor changes in CP such as age, sex, gestational age, CP type based on topography, asphyxia history, radiological features, head circumference, visual impairment, hearing loss, epilepsy and duration of CP.

Objectives. The research aims to find the clinical characteristics of CP, gross motor changes based on GMFCS and the factors that influence it.Method. The study was cross sectional to see gross motor changes based on GMFCS and the factors that influenced it. The analysis used to determine the relationship is MacNemar and kai square test.

Results. The case of CP was greater in male 61, mature birth 75, tetraplegi type 66, abnormal radiology 83,3 , abnormal head circumference 83 and epilepsy 61 . There were significant improvements between GMFCS at the start of the diagnosis versus current GMFCS p "

"Spastisitas pada palsi serebral merupakan penyebab disabilitas terbesar pada anak-anak 80 . Akupunktur sebagai terapi tambahan diketahui dapat membantu mengurangi spastisitas pada anak dengan palsi serebral. Salah satu modalitas akupunktur dengan efek samping minimal dan aman untuk anak-anak adalah laserpunktur. Penelitian ini bertujuan mengetahui pengaruh laserpunktur pada titik GV20, GV14, LI4, GB34 dan LR3 terhadap spastisitas pada palsi serebral tipe spastik. Desain penelitian ini adalah uji klinis acak tersamar tunggal dengan kontrol. Melibatkan 60 pasien palsi serebral tipe spastik usia 2-10 tahun yang dibagi menjadi dua kelompok. Pasien yang menyelesaikan terapi hingga akhir penelitian adalah 52 orang, 8 pasien dinyatakan dropout. Kelompok perlakuan sebanyak 26 pasien mendapatkan terapi laserpunktur dan kelompok kontrol sebanyak 26 pasien mendapatkan terapi laserpunktur plasebo, masing-masing sebanyak 12 kali terapi dengan frekuensi 3 kali seminggu. Kemudian pada kedua kelompok dilakukan penilaian spastisitas menggunakan Modified Ashworth Scale MAS sebelum dan setelah mendapatkan perlakuan. Hasil penelitian menunjukkan terdapat penurunan nilai MAS setelah perlakuan pada kelompok laserpunktur dibandingkan kelompok laserpunktur plasebo p < 0,05; 95 IK = 2,616 - 15,230 , terdapat penurunan nilai MAS pada kelompok laserpunktur setelah perlakuan dibandingkan sebelum perlakuan p < 0,05; 95 IK = 2,354 - 11,030 , tidak terdapat penurunan nilai MAS pada kelompok laserpunktur plasebo setelah perlakuan dibandingkan sebelum perlakuan p > 0,05; 95 IK = -7,027 - 2,565 , dan terdapat penurunan nilai MAS 3,6 kali lebih besar pada kelompok laserpunktur dibandingkan kelompok laserpunktur plasebo OR = 3,6, p < 0,05 . Dapat disimpulkan bahwa laserpunktur pada titik akupunktur GV20, GV14, LI4, GB34 dan LR3 terbukti efektif terhadap penurunan nilai MAS dibandingkan dengan laserpunktur plasebo pada anak dengan palsi serebral tipe spastik.

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Spasticity is a common feature of cerebral palsy 80 and the most common cause of disability in children. Acupuncture as an adjunctive therapy is known to help reduce spasticity in children with cerebral palsy. One of the acupuncture modalities with minimal side effects and safe for children is laser acupuncture or laserpuncture. This study aims is to determine the laserpuncture effects on GV20, GV14, LI4, GB34 and LR3 to spasticity on spastic cerebral palsy patients. The study design is a randomized single blinded clinical trial, involving 60 patients aged 2 to 10 years, divided into two groups. Only 52 patients who completed therapy until the end of the study, 8 patients stated dropout. The treatment group 26 patients received laserpuncture therapy, and the control group 26 patients received laserpuncture plasebo, each patient get 12 times therapy with frequency 3 times a week. Both of groups evaluated for spasticity using Modified Ashworth Scale MAS before and after treatment. The results showed a decrease in MAS score after treatment p 0,05 95 CI 2,616 15,230 in the laserpuncture group compared to the placebo group, a decrease in MAS score in the laserpuncture group after treatment p 0,05 95 CI 2,354 11,030 compared to before treatment, there is no improvement in the placebo group after treatment p 0,05 95 CI 7,027 2,565 compared to before treatment, and there was a decrease in MAS score 3,6 time greater in the laserpuncture group compared to the placebo group OR 3,6, p 0,05 . It can be concluded that laserpuncture therapy more effectively reduce MAS score in patients with spastic cerebral palsy compared to laserpuncture placebo. "

"The study and modulation of cortical connections is a rapidly growing area in neuroscience. The first section of the book describes studies of cortical connections, modulation of cortical connectivity and changes in cortical connections with activities such as motor learning and grasping in primates. The second section covers the use of non-invasive brain stimulation to study and modulate cortical connectivity in humans. The last section describes changes in brain connectivity in neurological and psychiatric diseases, and potential new treatments that manipulate brain connectivity. This book provides an up-to-date view of the study of cortical connectivity, and covers its role in both fundamental neuroscience and potential clinical applications."