The study acknowledges that eight non-responding centers were all private institutions. This introduces a potential sampling bias, as practices in private settings may differ significantly from the predominantly teaching/government hospitals that responded. The findings may not be fully generalizable to the entire ecosystem of epilepsy surgery centers in India, limiting the representativeness of the claimed national survey.
The reliance on self-reported data without any form of validation, such as auditing test reports, observing assessments, or verifying qualifications, is a major methodological weakness. There is a high risk of recall and social desirability bias, where respondents may over-report the use of ideal or standardized practices. This compromises the accuracy of the findings regarding the actual patterns of practice.
The finding that only 32% of neuropsychologists received supervised training and that 7% had no training is alarming. The quality of the neuropsychological data used for critical surgical decisions is directly dependent on the examiner’s competence. This significant variability in training fundamentally undermines the reliability and validity of the assessment data being integrated into the presurgical evaluation across these centers.
The use of outdated, international, or no normative data by a large proportion of centers (approx. 47%) is a critical error in practice that the study uncovers. Using decades-old norms or norms from different cultures can lead to profound misinterpretation of a patient’s cognitive status. This invalidates the baseline assessment and any subsequent measurement of change, rendering predictions of postoperative outcome and cognitive counseling highly unreliable.