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Epilepsy Surgery – Functional Adequacy and Reserve — SCE Neurology MCQ

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HardEpilepsy & Seizure DisordersEpilepsy Surgery – Functional Adequacy and ReserveSCE Neurology

A 40-year-old man with drug-resistant temporal lobe epilepsy undergoes evaluation for surgery. His neuropsychologist explains the concept of functional adequacy and functional reserve in pre-surgical memory assessment. What do these terms mean?

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Correct answer: E — Functional adequacy assesses how well the affected (to-be-resected) temporal lobe supports memory — high adequacy means resection risks significant memory loss. Functional reserve assesses whether the contralateral temporal lobe can compensate for memory after resection

In temporal lobe epilepsy surgery, the neuropsychological assessment evaluates: (1) Functional adequacy — how much the ipsilateral (surgical) temporal lobe contributes to memory. If it has high functional adequacy (i.e. it is the main memory-supporting structure), resection carries higher risk of post-operative memory deficit. (2) Functional reserve — whether the contralateral temporal lobe has sufficient capacity to support memory after the ipsilateral lobe is resected. High reserve = lower risk. This framework guides surgical decisions and patient counselling. A: They are different concepts. C: They apply to memory, not just language. D: Critical for temporal lobe surgery. E: They are current and essential.

Reference: ILAE Commission on Neurosurgery; NICE NG217