Das et al.¹ examined the epidemic of neurologic disability in India. As the authors noted, it is not just hidden but ignored. In large metropolitan areas such as New Delhi and Mumbai, excellent health care facilities currently exist for the treatment of acute stroke, traumatic brain injuries (TBI), and neurodegenerative conditions such as dementia. Patients from neighboring cities and villages flock to these centers to receive care. The time period after patients leave the hospital is the problem that is ignored by the government and medical community. In the absence of comprehensive TBI and stroke rehabilitation centers, patients are discharged and the burden of care falls on family and close friends. With few patients receiving comprehensive speech, physical, and occupational therapy, neurologic outcomes are poor, which adds to disease burden. In countries like India where resources are limited and demands high, neurologic disability from TBI and stroke can only be reduced if the emphasis is on prevention by modification of respective risk factors. This should be reflected in the national health policies of these countries, with adequate allocation of resources toward primary prevention of TBI and stroke as well as establishment of nursing homes and other subacute facilities to take care of these patients after discharge.

I read the article by Das et al.¹ with interest. Das et al.¹ correctly identify TBI, dementia, and stroke as contributors to the epidemic of neurologic disability. Epilepsy should also be included. Epidemiologic studies have suggested that there are 10–12 million Indians with epilepsy and approximately 73%–78% are not receiving appropriate treatment.² Within India, the treatment gap varies widely between the rural and urban regions and a treatment gap of up to 90% has been reported for rural populations.³ Disability in epilepsy remains largely hidden. The connection with disability in the context of epilepsy is rarely discussed. When it is mentioned, intellectual disability is often the focus. Untreated or inadequately treated epilepsy commonly leads to other forms of disability: loss of an eye, limb, teeth, or digit, or burn-related injury. It is vital to include epilepsy when calculating neurologic disability because it is preventable in those who are treatment naive as they respond well to antiepileptic drugs. Mandatory inclusion of “Axis 5” from the 2001 ILAE report³ in the diagnosis of all patients with epilepsy may be a beginning.