Background: We developed an automated smart phone application for detection of acute stroke using machine learning (ML) algorithms for recognition of facial asymmetry, arm weakness, and speech changes. Methods: We analysed prospectively collected data from patients admitted to 4 major metropolitan stroke centers with confirmed diagnosis of acute stroke. Speech and facial data were captured via video recording and arm data was captured via device sensors. A. Face. This module extracts 68 facial landmark points that are passed through a dimensionality reduction step and an asymmetry classifier. We implemented and compared 26 classification methods with neurologists' clinical impression and determined Quadratic Discriminative Analysis as the best one in terms of accuracy and interpretability. B. Arm. Using data extracted from 3D accelerometer, gyroscope, and magnetometer , we designed a grasp agnostic classifier based on AdaBoost to process motion trajectories and detect arm weakness.C. Speech. We developed an algorithm based on frequency analysis and Mel Frequency Cepstral Coefficients (MFCC) to detect abnormal/slurred speech. All tests were conducted within 72 hours of admission. Each of the three ML outputs was correlated with neurologists’ clinical impression. Results: Among the 269 analysed patients, 41% were female, the median age was 71, % had hemorrhagic and % had ischemic stroke. Final analyses of 18311 facial images revealed 99.42% sensitivity, 93.67% specificity, and 97.11% accuracy in detection of facial asymmetry. The results for 43 arm trajectories revealed 71.42% sensitivity, 72.41% specificity, and 72.09% accuracy in detection of arm weakness. Preliminary analysis of MFCC algorithms confirmed adequate features for abnormal speech detection Conclusions: Our preliminary results confirm that smartphone enabled ML-algorithms can reliably identify acute stroke features with accuracy comparable to neurologists’ clinical impression.

Cerebrovascular diseases are the leading cause of morbidity and mortality worldwide. Unfortunately, Bulgaria leads most countries in its incidence of stroke. Furthermore, a substantial number of Bulgarian patients post-stroke present with persisting communication disorders, especially aphasia. The main purpose of the present study is to conduct an evidence-based theoretical review of leading international guidelines for treatment and rehabilitation of adult stroke patients. In particular, this theoretical overview compares the current Bulgarian guidelines with those developed by the United States of America, Europe, Australia, Canada, the United Kingdom, and New Zealand. The Bulgarian guidelines for the prevention, diagnosis, and treatment of cerebrovascular diseases strongly recommends pharmacological treatment, which is commensurate with international standards. Nationally, a range of different language tests are currently used in post-stroke aphasia.

Background: Parkinson’s disease (PD), which occurs in 1% of the population, is the second most common neurodegenerative disorder. Despite the broad spectrum of PD manifestations and high disease prevalence, there are insufficient data on medicine utilization and prescription strategies. The purpose of the current study was to analyze published data concerning treatment approaches and to compare them with Bulgarian therapeutic practice.Design and methods: We conducted a systematic review of the PubMed and Google Scholar databases, and we calculated medicine utilization in Bulgaria during 2018 and 2019 using the WHO methodology.Results: The literature search identified a total of 311 publications, but only 12 met the inclusion criteria. Eleven studies pointed out that levodopa-containing medicine are the most frequently used, followed by dopamine agonists. The highest rate was found for levodopa-containing products and decarboxylase inhibitor (1.06 and 1.33 DDD/1000 inh/day), followed by anticholinergic Biperiden (0.494 and 0.455 DDD/1000 inh/day) during 2018 and 2019 in Bulgaria.Conclusion: Overall, the treatment approaches used in the last decade comply with guideline recommendations, despite variations in levodopa and dopamine agonist utilization. Even though new medicines have been approved for PD management, levodopa-containing products are still most often prescribed and used worldwide.