Mamta BhushanSingh, Neurologist, All India Institute of Medical Sciences, New Delhimbsneuro@gmail.com
Submitted December 03, 2012
Authors rightly identify TBI, dementia, and stroke as contributors to the epidemic of neurological disability. However, in this context, it is also crucial to remember epilepsy. Epidemiological studies have suggested that there are 10-12 million Indians with epilepsy and approximately 73-78% are not receiving appropriate treatment. [1] Within India, the treatment gap varies widely between the rural and urban regions, and a treatment gap of as much as 90% has been reported for rural populations. [2] Disability in epilepsy remains largely hidden. There is rarely mention of disability in the context of epilepsy and even when discussed, intellectual disability is often the focus. However, the challenge with untreated or inadequately treated epilepsy is its' frequent association with disability of many more forms. Among Indian patients with active epilepsy, loss of an eye, limb, teeth, digit or burn-related disabling injuries are common. It is vital to included 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 report [3] in the diagnosis of all patients with epilepsy may be a beginning.
1. Ray B, Bhattacharya S, Kundu T, Saha S, Das S. Epidemiology of epilepsy
--Indian perspective. J Indian Med Assoc. 2002; 100: 322-326.
2. Meyer AC, Dua T, Ma J, Saxena S, Birbeck G. Global disparities in the
epilepsy treatment gap: a systematic review. Bulletin of the World Health Organization. 2010; 88: 260-266.
3. Jerome Engel, Jr. ILAE Commission Report. A proposed diagnostic scheme
for people with epileptic seizures: Report of the ILAE Task Force on Classification and Terminology Epilepsia 2001; 42: 796-803.
For disclosures, please contact the editorial office at journal@neurology.org.
Authors rightly identify TBI, dementia, and stroke as contributors to the epidemic of neurological disability. However, in this context, it is also crucial to remember epilepsy. Epidemiological studies have suggested that there are 10-12 million Indians with epilepsy and approximately 73-78% are not receiving appropriate treatment. [1] Within India, the treatment gap varies widely between the rural and urban regions, and a treatment gap of as much as 90% has been reported for rural populations. [2] Disability in epilepsy remains largely hidden. There is rarely mention of disability in the context of epilepsy and even when discussed, intellectual disability is often the focus. However, the challenge with untreated or inadequately treated epilepsy is its' frequent association with disability of many more forms. Among Indian patients with active epilepsy, loss of an eye, limb, teeth, digit or burn-related disabling injuries are common. It is vital to included 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 report [3] in the diagnosis of all patients with epilepsy may be a beginning.
1. Ray B, Bhattacharya S, Kundu T, Saha S, Das S. Epidemiology of epilepsy --Indian perspective. J Indian Med Assoc. 2002; 100: 322-326.
2. Meyer AC, Dua T, Ma J, Saxena S, Birbeck G. Global disparities in the epilepsy treatment gap: a systematic review. Bulletin of the World Health Organization. 2010; 88: 260-266.
3. Jerome Engel, Jr. ILAE Commission Report. A proposed diagnostic scheme for people with epileptic seizures: Report of the ILAE Task Force on Classification and Terminology Epilepsia 2001; 42: 796-803.
For disclosures, please contact the editorial office at journal@neurology.org.