Bulgarian Brain Council: Experts Outlined Priorities for the Future Bulgarian National Brain Plan

Only 13% of Bulgarians recognize the symptoms of stroke

Findings from surveys conducted among members of the Bulgarian Society of Neurology, the Bulgarian Society of Neurosurgery, and the Bulgarian Psychiatric Association were presented today (June 9, 2025) during the media event “Brain Health – A Global Priority,” organized by the Brain Health Council Foundation. These expert opinions will form the basis for defining the key priorities in the upcoming National Brain Plan.

Prof. Dimitar Maslarov, Head of the Department of Neurology at University First General Hospital “St. John the Baptist” – Sofia and Board Member of the Brain Health Council Foundation, presented the major achievements in neurology over the past five years, along with short- and long-term scientific and organizational challenges. Significant progress has been made in the diagnosis and treatment of neurological disorders – from the application of artificial intelligence and modern neuroimaging diagnostics to new innovative therapies for multiple sclerosis, migraine, and rare genetic conditions. At the same time, the network of specialized stroke centers in Bulgaria is expanding, and the participation of Bulgarian research institutions in European research programs is growing. However, major challenges remain: a shortage of neurologists, regional disparities in access to care, delayed access to innovative therapies, the need for digitalization, development of scientific infrastructure, and strategies to retain young professionals in the country.

Prof. Georgi Onchev, Deputy Chair of the Bulgarian Psychiatric Association, discussed the achievements and challenges in psychiatric care in Bulgaria. In the past five years, psychiatry has advanced in key scientific areas – from genetic studies and biomarker development to innovative therapies, cutting-edge treatment methods, telepsychiatry, and digital solutions. Among the most urgent short-term challenges are the acute shortage of specialists, the need to reform specialization training, the development of day centers and protected housing, and improved interinstitutional cooperation. In the long term, the focus must be on overcoming stigma at the systemic level, introducing integrated care between psychiatry and social services, digitizing the sector, and investing in outpatient care as a sustainable alternative to institutional care.

Prof. Nikolay Gabrovsky, Corresponding Member of the Bulgarian Academy of Sciences, Chair of the Brain Health Council Foundation and of the Bulgarian Society of Neurosurgery, shared recent scientific developments and challenges in neurosurgery. Among the most significant achievements are advanced endovascular therapies, the rise of robotic surgery and artificial intelligence, and innovative developments in brain-machine interfaces and implantable neurochips. On the organizational level, notable milestones include hosting the 24th European Congress of Neurosurgery in Sofia (EANS 2024), publishing a Bulgarian-language textbook, recognition of the EANS exam for trainees as equivalent to the theoretical part of the Bulgarian specialization exam, and improved reimbursement for spinal implants. Short-term challenges include the urgent need for accelerated training and qualification, addressing staff shortages – particularly in healthcare support professions – and the lack of rehabilitation and post-acute care facilities. Long-term priorities include developing gene and immunotherapy for brain tumors, integrating high-tech solutions into clinical practice, and building modern centers that provide comprehensive care for patients with brain disorders.

Arkadi Sharkov, health economist and Board Member of the Brain Health Council Foundation, presented alarming data on the increasing number of traumatic brain injuries caused by e-scooter accidents. These incidents result in significant losses for both the healthcare system and the economy. According to the data, 80–90% of e-scooter accidents are solo falls, with 30–50% resulting in traumatic brain injuries. High risk is primarily associated with night riding, alcohol consumption, and lack of helmet use – fewer than 20% of the injured use protective gear. Other challenges include high speeds in urban settings, scooter instability, and lack of infrastructure. The most affected group consists of young men aged 20 to 35. In Bulgaria, in the first 7 months of 2024 alone, 192 injuries and 5 fatalities from e-scooter accidents were reported. These numbers mark an increase compared to the previous year and place Bulgaria among the high-risk countries in terms of growth rate of such incidents, though total numbers still remain lower than in countries like Germany, Italy, and France.

The economic impact is also significant. In addition to healthcare costs, there is a major loss of productivity associated with long-term work absences, particularly in cases of severe brain injury. Internationally, stricter regulations are being implemented – including speed limits, bans on urban riding, mandatory helmets and insurance. Countries like France, Italy, and Norway are introducing further measures such as minimum age requirements, registration numbers, and bans on scooter rentals.

The Brain Health Council Foundation proposed the following specific measures:

• Limiting night-time riding or restricting speed;

• Speed limits in pedestrian areas;

• Strict ban on riding under the influence of alcohol or drugs;

• Differentiated restrictions depending on the power of the e-scooter. Above a certain power threshold, certification and a motorbike helmet should be required;

• Raising public awareness through targeted campaigns and institutional partnerships.

During the event, current data on the economic burden of stroke – one of the leading brain disorders – was also presented. According to Global Burden of Disease (GBD) estimates, in 2021 there were around 11.9 million incident stroke cases, 160 million disability-adjusted life years (DALY), and 7.3 million deaths worldwide. In Bulgaria in 2022, nearly 41,000 patients received hospital treatment under clinical pathways, which cost the National Health Insurance Fund nearly 360 million BGN.

According to a May 2025 survey by “Trend” among 1001 respondents over 18, 86% of Bulgarians consider stroke to be a “very serious” condition. Nevertheless, awareness of its early symptoms is insufficient – only 13% are “fully informed,” while over 50% are poorly informed or not informed at all. This highlights the need for broader educational campaigns for early recognition and prevention.

In closing, Prof. Nikolay Gabrovsky summarized the key challenges facing Bulgaria’s brain health system. These include the lack of comprehensive, integrated, and interdisciplinary medical services, and the inefficient distribution of human resources due to the high number of medical facilities.

A major issue is the absence of specialized post-acute and rehabilitation units for severe cases – such as stroke, traumatic brain injuries, dementia, and degenerative diseases – which present serious social challenges. There is also a critical shortage of personnel, especially healthcare professionals, necessitating accelerated training and tiered preparation levels for new staff.

Another challenge is the rapid introduction of new technologies like artificial intelligence and robotics, which makes continuing medical education an urgent necessity.