Can Neuropsychological Rehabilitation Determine the Candidacy for Epilepsy Surgery? Implications for Cognitive Reserve Theorizing

Objective: The purpose of this study was to explore the effectiveness of a neuro-optimization intervention to determine the suitability for surgery in a patient suffering from left medial temporal lobe epilepsy (MTLE) and hippocampal sclerosis (HS). The rehabilitation program was aimed at amplifying cognitive resources and improving memory functioning, particularly in the non-dominant healthy hemisphere. Method: A preoperative neuro-optimization program, inspired by the functional reserve model and the right hemisphere’s verbal processing potential, was adopted. This neuro-optimization program targeted global cognitive and metacognitive enhancement with an emphasis on memory functions of the right temporal lobe, i.e., the functional upgrade of the healthy right hippocampus and related structures to assist memory after surgery. Results: After a 32 weeks neuro-optimization program, the patient once again underwent intracarotid amobarbital test (IAT). This time his right hemisphere memory functioning yielded a borderline score, allowing us to consider surgery. Immediately after surgery, the patient was seizure free and did not show any clinically significant memory impairment. At six months post-surgery he had largely preserved memory optimization gains. Conclusion: Preoperative optimization interventions aiming at enhancing cognition, in general and memory of the healthy hemisphere, in particular, may contribute to a positive memory outcome after left selective amygdalohippocampectomy.