Burden of Neurological Disorders in Resource-Limited Settings: Lessons from Pakistan for Global Neurology

Neurological disorders (NDs) are a leading global cause of disability and mortality, with their burden falling disproportionately on low- and middle-income countries (LMICs). Pakistan exemplifies the systemic challenges faced in resource-limited settings, including delayed diagnosis, limited specialist access, and fragmented care pathways. Despite this, comprehensive spectrum-based data remain scarce. This study was aimed to quantify the burden and characterize the spectrum of NDs presenting to a major Pakistani tertiary-care center and to identify associated predictors and geographic disparities. A hospital-based crosssectional study was conducted from May 2023 to January 2024, enrolling 537 consecutive patients with confirmed NDs. Descriptive statistics and logistic regression models were employed. Neurodevelopmental disorders were most frequent (31%), followed by neurovascular (20%), epilepsy (14%), autoimmune neurological disorders (12%), neurodegenerative (8%), neuroinfectious (7%), and neuromuscular disorders (6%). Logistic regression revealed strong age- and sex-dependent patterns, including markedly higher odds of neurodegenerative disorders in males and increased odds of neurovascular disorders with older age. Geographic analyses demonstrated a high burden of autoimmune and neuromuscular disorders among patients traveling >100 km, particularly from Khyber Pakhtunkhwa (KPK) and Azad Jammu Kashmir (AJK), highlighting significant access inequities. This study provides comprehensive clinical snapshot of NDs in Pakistan, revealing distinct epidemiological patterns shaped by socioeconomic disparities, geographic inequities, and genetic factors, such as consanguinity. The findings underscore the urgent need for strengthened neurological services, decentralization of specialized care, improved diagnostic capacity, early-interventions, and national surveillance systems. Lessons from Pakistan mirror broader challenges across LMICs and highlight the global imperative to invest in equitable neurological healthcare.