M.Wasay   ( Department of Neurology, The Aga Khan University. Karachi. )

The incidence or prevalence of major neurological diseases in our country is not known. National health survey identified 33% prevalence of hypertension in age group of 45 or older.¹ There are 2.7 million diabetics and 20% adult men and women using pan or tobacco.² Although incidence of stroke or intracerebral hemorrhage is not known but due to high prevalence of cerebrovascular risk factors we can assume, that it is io less than any western country. Tetanus, rabies and polio are still prevalent in epidemic proportions despite availability of effective vaccines. Overall burden of neurological diseases is 10-15% in different countries. Approximately 5 million people suffer from neurological diseases in Pakistan. There are 70 neurologists for 140 million people in Pakistan (one neurologist for every two million people). Out of these, 40 are trained in Pakistan.³ These 70 neurologists are concentrated in 15 hospitals in seven cities.
This issue of JPMA is dedicated to neurological diseases and availability of neurological care in Pakistan. Various original studies on epilepsy, meningitis, stroke, neurology training and neuroimaging facilities in Pakistan are reported. These studies indicate that neurological diseases are highly prevalent in our society and as a country we are not properly equipped to prevent or treat these problems.
Neurolouical diseases are at large, preventable, treatable and curable, if properly diagnosed and treated. Effective preventive and therapeutic strategy could not only decrease the disease burden in our society but also reduce the disability. Actions are needed in multiple directions both from government health agencies and from private health organizations to improve this dire situation.
Number of neurologists should be increased five fold in next five years. This is possible by recruiting foreilln trained Pakistani neurologists and starting -15-20 more neurology residency programs. All major hospitals and medical schools and universities must have a neurology section or department. Federal government should allocate funds for supporting neurology training programmes.
A well equipped National Institute for Neurloygical Diseases should be established by government with the support of private sector. This institute will serve as hub for neurological research, specialized training and quality care. All the neurology care hospitals and centers should be linked to this institute.
Increasing public awareness about neurological diseases and role of neurologists in treating these diseases is important in improving quality of care in our country. This could be done with the help of media. Neurological societies must play a key role in this regard.
A national health survey should be conducted for incidence and prevalence of neurological diseases. especially stroke, epilepsy, headaches, brain tumors etc. This survey will serve as the basis for long term planning related to neurological care. training and man power.
Cost of care for neurological diseases is high due to expensive, imported medications. Immunoglobulins. interferons, triptans and tPa are a few of those. The cost of these drugs could be reduced by local preparation or regulatory modifcations.

1.National health survey of Pakistan 1995. Pakistan Medical and Research Council, pp. 50-51
2.National health survey of Pakistan 1998. Pakistan Wdical and research eounel1, pp. 72-73
3.Hvder SS. Neurological training in Pakistan .J Pak Med Assoe 2003;53:623-24.