雌激素替代治疗大鼠海马结构PKC阳性细胞的变化

目的 :观察雌性大鼠行去势后以及雌激素替代治疗海马结构蛋白激酶C ( proteinkinaseC ,PKC)阳性细胞的变化 ,通过该模型研究绝经期后女性情绪烦躁、记忆下降等神经精神症状的分子机制。方法 :将大鼠分为对照组、去势 3个月组和去势后雌激素替代治疗 3个月组 ,用免疫组织化学方法检测海马结构PKC阳性细胞的变化。结果 :PKC阳性细胞主要分布于下托和齿状回的颗粒层 ,其中齿状回内的阳性细胞较下托的多。去势 3个月组与对照组相比 ,齿状回内的PKC阳性细胞没有显著性减少 (P >0 .0 5 ) ,下托PKC阳性细胞显著减少 (P <0 .0 5 ) ;雌激素治疗组与对照组相比 ,下托细胞数量有所减少 ,但无显著性差异 (P >0 .0 5 )。结论 :海马结构下托PKC阳性细胞的减少可能在绝经后女性情绪烦躁、记忆下降等症状中起重要的作用。     

穹窿海马伞损伤对大鼠学习记忆和海马GFAP阳性神经胶质细胞的影响

为探讨穹隆海马伞损伤鼠学习记忆能力与海马胶质纤维酸性蛋白阳性细胞之间的关系 ,切断 SD成年大鼠左侧穹窿海马伞 ,用 Y迷宫和免疫组织化学结合图像分析系统测试大鼠学习记忆能力和海马胶质纤维酸性蛋白阳性细胞的变化状况及它们的相互关系。结果显示 :损伤 2周后 ,损伤组损伤侧海马 CA1 区辐射层和齿状回分子层胶质纤维酸性蛋白阳性细胞的数密度较正常组分别增多 3 0 .2 9%和 3 0 .15 % (都为 P<0 .0 1) ,胞体面积分别增加 16.0 4%和 19.42 % (都为 P<0 .0 1) ,齿状回分子层胶质纤维酸性蛋白阳性细胞体密度增大 19.40 % (P<0 .0 5 )。经相关分析 ,大鼠学习记忆能力与海马 CA1 区胶质纤维酸性蛋白阳性细胞数密度呈负相关 (r=-0 .83 6,P<0 .0 1) ,与齿状回数密度呈负相关 (r=-0 .792 ,P<0 .0 1)。提示海马星形胶质细胞可能参与学习记忆过程     

苯丙胺对大鼠学习能力和海马结构GFAP阳性细胞结构的影响

目的观察苯丙胺对大鼠学习能力、GFAP免疫阳性细胞结构和亚细胞结构的影响。方法苯丙胺腹腔注射SD大鼠,用水迷宫检测其空间辨别性学习能力,用免疫组织化学方法观察海马结构胶质纤维酸性蛋白(GFAP)免疫阳性细胞的形态变化;用电镜方法检测GFAP免疫阳性细胞超微结构变化。结果学习能力检测发现,在14d以前,苯丙胺组大鼠较生理盐水组的平均运行时间和平均潜伏期缩短(P0.05);在15～28d,苯丙胺组大鼠较生理盐水组正确率降低(P0.05);在29～42d,苯丙胺组大鼠较生理盐水组正确率降低、平均运行时间延长(P0.05)。GFAP阳性细胞形态学观察发现,正常对照组大鼠海马结构星形胶质细胞主要分布在海马以及齿状回的多形层和分子层;生理盐水组大鼠海马结构星形胶质细胞分布与游水组相似,但细胞突起变长及增粗,分支增多,且各亚区比正常对照组相应亚区的星形胶质细胞数量增多(P0.05);苯丙胺组大鼠海马星形胶质细胞分布与正常对照组相似,但细胞突起变长、增粗和分支增多更明显,各亚区的星形胶质细胞比正常对照组和生理盐水组相应亚区增多(P0.05);电镜观察发现苯丙胺组大鼠脑内星形胶质细胞增生肥大,亦可见退变星形胶质细胞。结论在本实验条件下,苯丙胺导致大鼠空间辨别性学习记忆能力下降,引起大鼠海马结构星形胶质细胞增生和损害。     

氯化锂匹罗卡品诱导癫痫大鼠海马神经元GPER1表达的变化

目的:观察G蛋白偶联雌激素受体1(GPER1)在癫痫大鼠海马神经元中表达的变化。方法:成年雄性SD大鼠分成对照组(control)和癫痫组(epilepsy),利用腹腔注射氯化锂-匹罗卡品方法制备癫痫模型,分别在1、2、3、7、14 d和28 d,利用Morris水迷宫检测大鼠学习记忆能力,利用尼氏染色观察大鼠海马神经元形态变化;利用免疫组化和Western Blot技术观察GPER1在海马的表达。结果:水迷宫结果显示,与Control组相比,造模14 d的大鼠逃逸潜伏时间明显延长(P 0. 05),穿越目标象限区域的次数较Control组显著降低(P 0. 05)。尼氏染色结果显示:与Control组相比,造模1 d和2 d的大鼠CA1及CA3区锥体细胞层细胞及DG区颗粒细胞层细胞体积缩小,细胞间距增加,尼氏染色减弱;造模3和7 d的大鼠细胞体积明显缩小,细胞间隙明显增大,尼氏染色加深,CA1及CA3细胞数量明显减少;造模14 d和28 d的大鼠神经元体积逐渐向正常恢复,但仍较Control组小。免疫组化结果显示:GPER1免疫阳性细胞以海马锥体细胞和齿状回颗粒细胞为主,主要分布在细胞膜。与Control组相比,造模2 d和3 d的大鼠海马CA1及CA3区GPER1表达增加(P 0. 05),7 d后增加最明显(P 0. 01),14、28 d后表达下降;在DG区,造模3 d及7 d的大鼠GPER1表达增加(P 0. 05),14 d后表达下降(P 0. 05),28 d大鼠无显著差异。Western Blot结果显示:与Control组比较,造模2 d和3 d的大鼠GPER1相对表达量开始增高,7 d后明显增高(P 0. 05),14 d及28 d的大鼠表达降低。结论:GPER1在海马神经元的表达随着神经元损伤的加重而增高,随着神经元损伤的恢复逐渐降低,提示其表达变化与神经元的损伤与修复有关。     

脑缺血模型大鼠海马CRF、PKC蛋白表达研究

目的： 观测脑缺血再灌模型大鼠海马神经细胞CRF、PKC蛋白表达变化。方法: 采用免疫组化技术检测脑缺血模型大鼠于再灌2 h、6 h、24 h时海马神经细胞CRF、PKC蛋白表达量，CRF拮抗剂对照。结果: (1)CRF：假手术组海马区可见少量阳性细胞；模型组见大量阳性细胞，着色深，随时间延长增多。拮抗剂组阳性表达较少，着色较浅。模型组和盐水组CRF蛋白阳性表达面积均显著高于假手术组和CRF拮抗剂组（P<0.01）。(2)PKC：假手术组海马区阳性表达颗粒少，模型组和盐水组见大量阳性表达颗粒，拮抗剂组阳性表达颗粒稀疏。模型组和盐水组CRF蛋白阳性表达面积均显著高于假手术组和CRF拮抗剂组（P<0.01）。结论: 脑缺血再灌诱导CRF、PKC蛋白高表达是导致海马神经细胞迟发性死亡的重要因素；CRF蛋白激活PKC蛋白表达可能是CRF诱导缺血后神经组织损伤的机制。     

慢性复合应激增强大鼠海马Doublecortin的表达

目的 探讨慢性复合应激性学习记忆增强大鼠海马齿状回(DG)新生神经元数量变化以及Doublecortin(DCX)在海马组织中表达的变化及其意义.方法 成年雄性大鼠随机分为复合应激组和正常对照组.复合应激组动物每天交替暴露于复合应激原中达6周.实验结束后,所有动物分别进行3d的Morris水迷宫测试,记录其学习和记忆成绩.运用免疫细胞化学方法观察海马DG新生神经元数量的变化,同时运用Western blotting和RT-PCR技术分别检测DCX在海马的表达及其mRNA水平的变化.结果 与对照组相比,复合应激组动物的学习与记忆成绩优于对照组(P＜0.05);其海马DG新生神经元数明显增多(P＜0.05);海马DCX蛋白的表达明显增加(P＜0.05);海马DCX mRNA水平明显上调(P＜0.05).结论 慢性复合应激致大鼠的学习与记忆能力增强,海马DG内DCX阳性细胞数增多,提示新生神经元数量增加是导致大鼠学习记忆能力增强的原因之一.     

PKCβ抑制剂LY333531对大鼠糖尿病模型肾脏巨噬细胞浸润的影响

探讨PKCβ抑制剂LY3335 31对大鼠糖尿病模型肾组织巨噬细胞浸润的影响。建立STZ诱导的大鼠糖尿病模型 ,随机分对照组、模型组与LY3335 31给药组 ,每组 1 0只。 8周后检测 2 4h尿白蛋白排泄率 (AER )及肾组织PKC活性 ;PAS染色观察肾小球病理形态学指标 ;应用免疫组化方法检测肾组织ED 1及MCP 1、ICAM 1表达。结果 :(1 )模型组大鼠肾重、肾重/体重、AER及肾小球面积、肾小球容量、系膜区面积明显高于对照组 (P <0 0 5 ,P <0 0 1 ) ,LY3335 31给药组这些改变明显减轻 (P <0 0 5 ) ;(2 )LY3335 31给药组肾组织细胞膜、细胞浆PKC活性明显低于模型组 (P <0 0 5 ) ;(3)模型组肾小球ED 1阳性细胞数及MCP 1、ICAM 1表达明显高于对照组 ,LY3335 31给药组肾小球ED 1阳性细胞数及MCP 1、ICAM 1表达明显低于模型组 (P <0 0 5 )。表明LY3335 31对糖尿病大鼠肾脏有明显保护作用 ,其机制可能部分与抑制肾组织巨噬细胞浸润有关。     

NF-KB在发育鼠戊四氮反复点燃癫痫形成中的作用

目的:用NF-KB阻滞剂吡咯烷二硫基甲酸盐(PDTC)阻断NF-KB的表达,探讨核因子KB(NF-KB)在发育鼠戊四氮(PTZ)点燃癫痫形成过程中的作用.方法:生后10 d(P10)Wistar大鼠72只,随机分为PTZ组、PDTC PTZ组及生理盐水对照组3组,制备戊四氮反复点燃癫痫模型.观察各组大鼠行为学改变、海马各区细胞形态及细胞计数、NF-KB表达、5-溴-2-脱氧尿嘧啶核苷(BrdU)阳性细胞数和苔藓纤维发芽等指标.结果:(1)NF-KB表达,PTZ组显著高于对照组及PDTC PTZ组(P<0.01);(2)海马神经细胞计数,PTZ组齿状回(DG)区颗粒细胞较对照组显著增加(P<0.05);PDTC PrZ组CAI、CA3和门区神经元数较PTZ组均明显减少(P(0.05);(3)DG区BrdU阳性细胞数,PTZ组和PDTC PTZ组均较对照组显著增加(P<0.01);PDTC PTZ组DG区BrdU阳性细胞数目明显较PTz组少(P<0.01);NF-KB吸光度值与BrdU阳性细胞数／颗粒细胞数相关性分析呈正相关,具有统计学意义(P<0.01);(4)苔藓纤维发芽,PDTC PTz组和PTZ组均有苔藓纤维发芽,两组比较没有显著差异.结论:NF-KB在发育鼠癫痫中发挥重要作用,促进海马神经元发生,保护海马神经细胞,但对苔藓纤维发芽无明显作用.     

运动预干预对睡眠剥夺大鼠学习记忆及海马nNOS表达的影响

目的:探讨跑台运动预干预对完全睡眠剥夺(TSD)大鼠空间学习记忆能力、海马单胺类神经递质水平和神经元型一氧化氮合酶(nNOS)表达的影响。方法:将40只大鼠随机分为对照组(CON)、运动组(EX)、完全睡眠剥夺组(TSD)及睡眠剥夺运动组(EX+TSD)。除CON组及TSD组大鼠,EX组和EX+TSD组大鼠进行跑台运动预干预4周,运动结束后建立大鼠72 h睡眠剥夺模型(小平台水环境法),然后运用八臂迷宫实验(ERM)评估大鼠空间学习记忆能力,用高效液相-电化学法检测大鼠海马单胺类神经递质多巴胺(DA)、去甲肾上腺素(NE)、5-羟色胺(5-HT)的表达水平,用免疫组化法检测海马一氧化氮合酶(nNOS)神经元的表达。结果:(1)与CON组比较,ERM实验中TSD组大鼠工作记忆错误次数(WME)、参考记忆错误次数(RME)均显著增多,正确反应的次数(CN)减少,完成八臂迷宫时间显著延长(P 0. 01);海马内DA及NE的水平均显著下降(P 0. 01),而5-HT的水平增加(P 0. 01),海马nNOS阳性细胞平均光密度显著增加(P 0. 01);(2)与TSD组比较,ERM实验中EX+TSD组大鼠WME及RME均显著减少,CN增多,完成八臂迷宫时间均显著缩短(P均0. 05); EX+TSD组海马DA的表达水平显著增加(P 0. 05),5-HT的表达水平下降(P 0. 05),NE的表达水平则无显著变化(P 0. 05),海马nNOS阳性细胞平均光密度显著下降(P 0. 05)。结论:规律的跑台运动预干预可以增强TSD大鼠的学习记忆能力,其机制可能与此运动下调大鼠海马内nNOS活性、减弱高浓度NO的神经毒性纠正TSD大鼠单胺类神经系统紊乱,对睡眠剥夺引起的海马神经元损害具有保护作用有关。     

BMP4参与海人酸损伤后成年大鼠海马齿状回颗粒细胞增殖及胶质增生

目的探讨海人酸（KA）侧脑室注射致大鼠海马损伤后骨形成蛋白-4（BMP4）的表达变化及其与颗粒细胞增殖和胶质细胞增生的关系。方法将成年大鼠分为对照组与实验组。侧脑室注射KA7d后,用尼氏染色检测海马神经元丢失,用免疫组织化学与原位杂交的方法检测海马齿状回BMP4mRNA阳性细胞与BrdU标记细胞、GFAP阳性细胞数的变化。结果正常成年大鼠BMP4mRNA阳性细胞主要分布于海马齿状回的门区、颗粒下层、CA3、CAI区。BrdU标记细胞主要分布在齿状回颗粒下层。GFAP阳性细胞主要分布在齿状回、CA3区。在KA侧脑室注射致海马损伤后7d,海马CA3、CA4区神经元丢失明显,BMP4mRNA阳性细胞与BrdU、GFAP阳性细胞均明显增加。结论KA侧脑室注射致海马损伤后,成年大鼠海马齿状回颗粒细胞增殖增强和胶质增生可能与BMP4表达增加有关。     

听源性惊厥易感大鼠惊厥和点燃后前脑结构内的c—fos表达

为探讨听源性惊厥点燃和前脑结构的关系，用免疫细胞化学方法结合体视学分析，研究Ｗｉｓｔａｒ种系的听源性惊厥易感大鼠惊厥和点燃后，前脑结构内ｃ－ｆｏｓ表达的差异。结果显示，１．正常Ｗｉｓｔａｒ大鼠接受一次强音刺激后，海马，齿状回，杏仁核，内嗅皮质，嗅周皮质和额－顶皮质内未见Ｆｏｘ阳性神经元；２．Ｐ７７ＰＭＣ大鼠一次惊厥后，除海马，齿状回外，上述被检各区内可见广泛的Ｆｏｓ阳性神经元，其分布具有区域差异．     

Abnormal neuronal excitability in hippocampal slices from kindled rats

To determine if electrophysiological properties of hippocampal pathways are altered in kindled rats, extracellular recordings were made from hippocampal slices of rats kindled in the lateral entorhinal cortex and compared with those from implanted but unstimulated controls. Studies were made either 24 h or 28 days after the last kindled seizure and done in normal (3.5 mM) or elevated (7 mM) K+. The preparation of slices, data accumulation, and data analyses were done blind. One day or 28 days after the last kindled seizure, the proportion of slices with spontaneous epileptiform bursts recorded from the CA2/3 region in elevated K+ was significantly (P less than 0.001) increased in the kindled animals. The frequency of spontaneous burst firing was also increased and reached significance (P less than 0.02) at 28 days following the last kindling stimulus. One day after the last kindling stimulus, paired-pulse (GABAergic) inhibition in the CA1 region was decreased (P less than 0.001). Several measures suggested an increased synaptic inhibition in the dentate gyrus of slices from the kindled groups 1 day after kindling. Paired-pulse inhibition was increased (P less than 0.01), the current required to evoke a near-threshold population spike was increased (P less than 0.05), and the population spike amplitude was reduced for a given field excitatory postsynaptic potential (EPSP) (P less than 0.01). Twenty-eight days after the last kindling stimulus, however, paired-pulse inhibition in the dentate was slightly less in slices from kindled rats (P less than 0.005). In other respects the CA1 and dentate regions did not differ between kindled and control groups within 24 h of the last stage V seizure. Thus the maximum amplitudes of presynaptic fiber volley, population spike, and field-excitatory postsynaptic potential (EPSP) slope, and the number of population spikes evoked by a near-maximally effective afferent stimulus, were unchanged. In the CA1 region the input-output curve of field EPSP versus population spike, and the current intensity required to evoke a near-threshold population spike were also unchanged. In addition, no spontaneous bursts were recorded from CA1 in 3.5 mM K+. We conclude that either synapses or neurons intrinsic to the hippocampus are altered by kindling stimuli applied outside this brain area. The transient increase in inhibition in the dentate gyrus suggests that it may reflect a compensatory reaction to kindled seizures. In contrast, the long-lasting (at least 28 days) increase in burst firing in CA2/3 may represent a mechanism for the initiation or propagation of kindled seizures.(ABSTRACT TRUNCATED AT 400 WORDS)     

Decreased levels of disrupted-in-schizophrenia 1 (DISC1) are associated with expansion of the dentate granule cell layer in normal and kindled rats

Disrupted-in-schizophrenia 1 (DISC1) is a candidate gene involved in the pathogenesis of schizophrenia. DISC1 expression is particularly abundant in the adult dentate gyrus, in which decreased levels lead to aberrant growth, impaired migration, and accelerated integration of adult generated neurons. Because seizures can also result in similar changes, we tested the hypothesis that DISC1 expression may be altered in an animal model of epilepsy. We found that extended amygdala kindling (i.e., 99-electrical stimulations) significantly decreased DISC1 labeling in the dentate granule cell layer and subgranular zone. Extended kindling also led to an increase in the number of ectopic granule cells in the hilus. In addition, although the width of the granule cell layer was not generally affected by kindling, decreased levels of DISC1 in the subgranular zone and granule cell layer were associated with an expansion of the upper blade and crest of the dentate gyrus in both normal and kindled rats. These novel findings suggest that seizure activity affects DISC1 signaling in the dentate gyrus and that DISC1 expression may regulate the cytoarchitectural organization of the granule cell layer.     

听源性惊厥易感大鼠点燃后海马结构内的突触素表达

为探讨听源性惊厥点燃对突触可塑性的影响，采用免疫细胞化学方法结合体视学分析，研究了Ｗｉｓｔａｒ种系的听源性惊厥易感大鼠（Ｐ７７ＰＭＣ）惊厥和点燃后海马结构内突触素ｐ３８表达的差异。结果显示：（１）Ｐ７７ＰＭＣ大鼠１次惊厥后，海马结构内ｐ３８免疫反应产物呈明显的板层样分布；（２）Ｐ７７ＰＭＣ大鼠点燃后，ｐ３８免疫反应产物的定位分布与１次惊厥后相比较，没有明显改变，但是，ｐ３８免疫反应产物的密度普遍增     

C57black/6小鼠全脑缺血模型的海马区Bcl-2和Bax的表达

使用 C5 7black/6小鼠制造的全脑缺血模型 ,观察全脑缺血后海马 Bcl-2和 Bax的表达 ,为这种新的模型在脑缺血研究中的应用提供实验依据。双侧颈总动脉夹闭 15 min诱发全脑缺血模型 ,2 4h后取脑组织进行 Bcl-2和 Bax免疫组织化学染色。缺血组海马 Bax阳性反应神经元数目增多 ,主要分布在 CA1 区 ,胞浆深染 ,假手术组 Bax阳性细胞数目少 ,染色浅。缺血组 CA3区和齿状回 Bcl-2阳性反应神经元数目增多 ,胞浆染色深 ,假手术组 Bcl-2阳性细胞数目少 ,染色浅。C5 7black/6小鼠全脑缺血模型的海马内 Bcl-2和 Bax表达发生改变 ,Bax表达增加在 CA1 区 ,Bcl-2表达增加在 CA3区和齿状回 ,提示二者在该模型的脑缺血后神经细胞死亡过程中发挥作用     

大鼠急性癫痫发作后齿状回分子层微血管构筑的改变

目的观测海人酸(KA)癫痫模型大鼠海马齿状回分子层微血管构筑的改变。方法采用KA癫痫模型(颈部皮下注射KA,10mg/kg),在造模后7天应用碱性磷酸酶法显示海马脑片片厚(90μm)的微血管,光镜观察,使用NIS-Element BR软件定量分析。结果海马内的微血管成层分布,构筑模式与神经元的构筑模式相一致;KA组的微血管数目明显多于对照组(P=0.003),血管平均长度明显高于对照组(P=0.000),血管平均直径无明显变化(P=0.121)。结论海马齿状回分子层微血管构筑在癫痫发病早期发生改变。     

Kindling induces transient NMDA receptor-mediated facilitation of high-frequency input in the rat dentate gyrus

To elucidate the gating mechanism of the epileptic dentate gyrus on seizure-like input, we investigated dentate gyrus field potentials and granule cell excitatory postsynaptic potentials (EPSPs) following high-frequency stimulation (10-100 Hz) of the lateral perforant path in an experimental model of temporal lobe epilepsy (i.e., kindled rats). Although control slices showed steady EPSP depression at frequencies greater than 20 Hz, slices taken from animals 48 h after the last seizure presented pronounced EPSP facilitation at 50 and 100 Hz, followed by steady depression. However, 28 days after kindling, the EPSP facilitation was no longer detectable. Using the specific N-methyl-D-aspartate (NMDA) and RS-alpha-amino-3-hydroxy-5-methyl-4-isoxazoleproponic acid (AMPA) receptor antagonists 2-amino-5-phosphonovaleric acid and SYM 2206, we examined the time course of alterations in glutamate receptor-dependent synaptic currents that parallel transient EPSP facilitation. Forty-eight hours after kindling, the fractional AMPA and NMDA receptor-mediated excitatory postsynaptic current (EPSC) components shifted dramatically in favor of the NMDA receptor-mediated response. Four weeks after kindling, however, AMPA and NMDA receptor-mediated EPSCs reverted to control-like values. Although the granule cells of the dentate gyrus contain mRNA-encoding kainate receptors, neither single nor repetitive perforant path stimuli evoked kainate receptor-mediated EPSCs in control or in kindled rats. The enhanced excitability of the kindled dentate gyrus 48 h after the last seizure, as well as the breakdown of its gating function, appear to result from transiently enhanced NMDA receptor activation that provides significantly slower EPSC kinetics than those observed in control slices and in slices from kindled animals with a 28-day seizure-free interval. Therefore, NMDA receptors seem to play a critical role in the acute throughput of seizure activity and in the induction of the kindled state but not in the persistence of enhanced seizure susceptibility.     

Increased afterdischarge threshold during kindling in epileptic rats

The effects of daily electrical kindling stimulation of the perforant pathway were investigated in an excitotoxic rat model of epilepsy with chronic seizures in order to learn whether the preexisting epileptic condition would facilitate or retard kindling. Sprague-Dawley rats with recurrent spontaneous seizures 4-8 months after unilateral intrahippocampal kainic acid (KA) injection were implanted with recording electrodes in the hippocampus and stimulating electrodes in the perforant path. Daily stimulation for 10 s at 5 Hz was given for 15 days. The afterdischarge (AD) threshold and the AD duration of kindled KA rats were compared before and during kindling with those of a kindled control group. In the control group, as expected, mean AD thresholds decreased ( P<0.01), while AD duration progressively increased. Although AD threshold was the same in KA and control groups at the start of kindling, in the KA group a significant increase in threshold occurred from the beginning to the end of kindling ( P<0.01). Behaviorally, KA rats showed stage 4 or 5 seizures on the first stimulation, and stage 3-5 seizures during the remainder of kindling. Paired pulse testing showed facilitation of late components of the dentate gyrus field potential at the beginning of kindling, and suppression of late components at the end, in the KA rats. A significant decrease in the rate of spontaneous seizures in KA rats was noted during the period of kindling ( P=0.04). These results suggest that electrical stimulation of the perforant path may strengthen homeostatic seizure suppressing mechanisms, and may provide insights into novel approaches to the treatment of clinical seizures in temporal lobe epilepsy.