Prof. Ekaterina Titianova, M.D.
Head of the Clinic of Functional Diagnostics of the Nervous System at the Military Medical Academy in Sofia, President of International Foundation Mexico–Bulgaria

Prof. Ekaterina Titianova is a neurologist, M.D., alumnus of the Medical University, Sofia. Her academic career began in 1983 as assistant professor in the Department of Neurology of the Medical Academy, Sofia. Later she headed the neurological ward in St. Nahum University Specialized Hospital for Active Treatment in Neurology and Psychiatry, and a laboratory of clinical neurosonology. Doctor of Science, from 2009 – professor of neurology. From 2005 she is head of the Clinic of Functional Diagnostics of the Nervous System at the Military Medical Academy in Sofia.
Prof. Titianova is the author or co-author of many monographs and textbooks and of over 130 publications in Bulgaria and abroad. She has specialized in transcranial doppler sonography in Austria and in Germany; in neurology in the United States, Austria and Mexico; motor control and gait disorders in the United States and Finland. Her research and collaborated research in the field of gait has been published and widely cited in foreign literature. Member of a number of national and international organizations and foundations, external expert to the National Health Insurance Fund. Coordinator of postgraduate programmes of the World Federation of Neurology for Bulgaria. Since 2005 she is President of the Bulgarian Society of Neurosonology and Cerebral Hemodynamics; since 2009 vice-president of the Stroke Prevention Foundation. She has been awarded national and international scientific awards.

• In Bulgaria the treatment of multiple sclerosis keeps abreast with the good models in other countries
• Can criminals be caught by their gait?
• And will the day come when we shall all be experts in telepathy?

Prof. Titianova does not look like a desk scientist at all. She is young, energetic, extremely charismatic. A citizen of the world, being invited worldwide as a specialist of impressive qualities. She is genuinely interested in what she does. She does not make it a secret that she loves to go deep into areas qualified as attractive. She is one of the most profound researchers of the secrets of the human brain. She does not shun reflecting on the paranormal and the psychics; she explains the importance of having objective proof of brain death; she thinks one’s gait can tell much about the state of one’s body and mind. These topics are curious and therefore they require responsibility – the thought of scientific weight and practical use never leaves her. In the vague for the non-specialist field of “transcranial doppler sonography” Prof. Titianova seeks ways to successfully solve the patients’ problems. She is the author of several monographs which are now primary reference literature for medical students. This method with a sophisticated name helps diagnose dozens of the most significant killer diseases. It also throws light on the widely discussed issue of definite establishment of brain death, without which no transplantation from a dead donor can be done with clear conscience.
You will not hear from Prof. Titianova that with so much pain and death around you, you get used to it. She will never get used to it. She accompanied her husband to Mexico, where she opened her heart for the country and its people, and spared no effort or time to promote the cultural, scientific and human exchange between the two countries. She shares thoughts with some of the greatest minds in medicine of our time, but the orphans at the home in her native Gotse Delchev bring tears to her eyes and so does the fate of a gift-sculpture ignored by the institutions.
And because Dr. Titianova always has a theme that is hotter than the rest, she speaks fervently about the international forum of leading neurologists from all parts of the world, which was held in Bulgaria and at which a revolutionary method of treatment of brain stroke was announced, where the blood clot can be broken down even at the acute phase and thus avoid complications such as paralysis, loss of memory and speech, hearing and visual impairments.
For Prof. Titianova the human brain resembles the Earth globe not only in shape but also because of the fact that it is impossible to grasp them by reason alone.

Prof. Titianova, how do Bulgarians fare in terms of incidence and severity of neurological disorders among the European nations? Are we sicker than the others?
Bulgarians have shorter lifespan compared to the citizens of the advanced European countries. Life expectancy in our country is lower by about 7–9 years – it is around 69 for men, and a little over 76 for women. In the countries with high living standards, however, the main health problems are related to aging and the wearing out of the body. While in Bulgaria the cardiovascular and cerebrovascular diseases are leading. In terms of mortality rate due to cerebral apoplexy (stroke) Bulgaria has been at the top of the list for decades. Also a tendency of “rejuvenation” is observed in strokes, predominantly in men. Lately, strokes in patients under 50 have multiplied, and this is very alarming.
Practice shows that Bulgarians constantly talk about sicknesses, but do not look after their health properly. Only when they get ill, they seek specialized aid.

I read an article with the promising title of “In 5 years we will have a cure for strokes at young age,” based on a conversation with you. Can we really hope this will happen?
These words were said by Prof. Ringelstein during his visit to Bulgaria for the Third Meeting of the Bulgarian Society of Neurosonology and Cerebral Hemodynamics with international participation, held in Sofia in 2008. He had in mind the modern trends of control of the risk factors conducive to apoplexy, including those related to genetic predisposition. However, the tests are too expensive to be applied in practice routinely. I am not optimistic that this can happen in Bulgaria in 5 years.

You are also a specialist in the treatment of multiple sclerosis. Why does this disorder “have a preference” for young people, too? Are there hopeful news from its investigation and treatment?
Multiple sclerosis is in principle a disorder of young age. Like any disorder of unclear cause, it is the subject of profound research all over the world. Despite the numerous and many-sided investigations, there is still no treatment leading to complete recovery.  In the attack-free periods immunomodulating drugs are applied, slowing down the disease progress. Treatment in Bulgaria keeps abreast with the good models in other countries. Bulgarian patients receive the same medications, and their dispensation is quite free of charge under programs of the National Health Insurance Fund (NHIF). There are many other, alternative drugs for disease control which are in the stage of trials worldwide. We are in a position to offer similar therapy to patients in Bulgaria, since most university clinics of neurology, including the Clinic of Functional Diagnostics of the Nervous System at the Military Medical Academy which I head, take part in such international multicentre researches. These are undertaken after permission is obtained from the competent authorities in Bulgaria, with volunteer patients who meet certain criteria. The treatment is completely free of charge, and the patients are scanned periodically by specialized teams, trained according to the international requirements for participation in such investigations.

You have lived and worked in Mexico. This country is traditionally interesting for Bulgarians. What impressed you most, both as a specialist, and as a person? What is the level of neurological aid there? Do you think your stay in Mexico has changed you in some way and why did you decide to become president of International Foundation Mexico–Bulgaria?
My stay in Mexico is one of the most remarkable and exciting periods in my life. I learned Spanish in order to have more adequate contact with the ancient culture of the Mexican people, to get familiar with their traditions and folklore, to be able to communicate with people.

The reason why I lived in Mexico City was the diplomatic assignment of my husband, Chavdar Rusev, who was head of the trade-economic service of Bulgaria and first secretary at the embassy. As a scientist and lecturer of long-standing at the Medical University, Sofia, I got in touch with the Mexican Institute of Neurology and shortly we signed an agreement for scientific cooperation. This enabled me to work at the leading institute of neurology in Mexico and to get acquainted with the Mexican scientific achievements. It turned out that their experience in transcranial doppler sonography was scanty, and this allowed me to train their specialists and set up a new laboratory of cerebral autoregulation and monitoring like the one I headed in Bulgaria.

The founding of Mexico-Bulgaria Foundation in 1998 was dictated by the shortage of funds for the realization of cultural exchange between the two countries. The Foundation gave us an opportunity to attract sponsors and hold Days of Bulgaria in Mexico. Exhibitions were organized of Bulgarian artworks (paintings and sculptures) and of Bulgarian embroidery. Young Bulgarian musicians gave concerts. We published two magazines – Bulgaria in Spanish, and Mexico in Bulgarian, which were distributed in the two countries. The Foundation’s activity was broadly covered by the Mexican press and radio. In 1998 the Foundation initiated the setting up of Mexico-Bulgaria Parliamentary Friendship Group at the Mexican parliament, whose chairman was Mr. Felipe de Jesus Cantu. He sent an official letter to the Bulgarian National Assembly and a related group was formed there, too. In the words of the president of the Private Assistance Council (Junta de Asistencia Privada) of Mexico Federal District, Victor Garcia Lizama, at that time the Foundation established itself as a “pioneer institution in the field of altruistic exchange between the two countries, whose activity enhances the ties of brotherhood and cooperation in rendering assistance to our fellow-men.”

During these events the famous Mexican sculptor Fanny Haiat donated to Sofia the monumental work Dancing Above The Clouds, which was transported to our capital in 1998 with the collaboration of Fundacion Mexico-Bulgaria I.A.P, the government of Mexico City, and Samuel Menache Gallery. Only after years the sculpture was installed in front of the National Gallery for Foreign Art in Sofia, but it still does not have a proper inscription. All this hurt Ms. Haiat, who had made a gesture of friendship and goodwill.

The Foundation’s activity did not receive adequate response on the part of the Bulgarian institutions, therefore when we came back we had to restrict its activity in Bulgaria. Two charity meetings were organized with the cooperation of Mrs. Diana Stella (who is of Mexican descent and is wife of the then permanent representative of the International Monetary Fund). Together with her we made a donation to the Ivan Kyulev Home for Children and Adolescents and to the children from Vasil Levski Special School in my hometown Gotse Delchev.

Luckily, the Mexican state still appreciates our foundation and reflects its activity in the webpage of the Private Assistance Council of Mexico Federal District. We are seeking new forms for its further development, which we plan to implement soon.

During the World Congress of Neurology held this October in Bangkok we renewed our contacts with the Manuel Velasco Suarez National Institute of Neurology and Neurosurgery and together with its director Dr. Tereza Corona Vazquez outlined the main lines of future cooperation.

You are doing research on motor control and gait disorders. Can one be characterized by one’s gait? What does “footprint analysis” mean?
Gait is one of the most attractive research topics to which I am dedicated. It is strictly individual and is part of the human biometric characteristics, similar in uniqueness to fingerprints. The thesis of the individuality and uniqueness of gait goes back to ancient times – in a stanza from a popular Russian song it says, “you know them by their gait,” and an Old German transcript of the Song of the Nibelungs mentions that from faraway south-eastern Europe came strangely dressed people, called Bugars (related to the Bogomils), who could tell various diseases “by the eyes and by the gait.”

Physiologically the normal gait is an aggregate of repeated rhythmic movements of the lower limbs, where each foot changes rhythmically, successively and reciprocally its contact with the surface for the purpose of keeping balance and translation of the body in space. If there is a morbid process of the skeleton muscles, the articulation apparatus, the spinal cord or the cerebrum, then the gait is altered – how? – it depends on the localization and kind of the disorder and the extent to which motor control over the lower limbs is impaired. The precise diagnosing of the disorders helps choose the right therapy and individualize neurorehabilitation.

Modern science provides suitable methods of biometric analysis of the gait (by studying its kinetics, kinematics and footprints), which confirm its uniqueness. This determines the trends of scientific research, aimed at creating an algorithm for personal identification by people’s gaits – a topical problem in criminology and in medicine.

I have specialized in the field of motor control of gait at the prestigious university centres in Huston (USA) and Kuopio (Finland). In 2007 I defended a dissertation on this topic, the first of its kind in Bulgaria, and was awarded the Doctor of Science degree. Presently I am working on the founding of the first laboratory for gait biometric analysis in our country.

What does “transcranial doppler sonography” mean? What practical applications does it have?
Transcranial doppler sonography is an ultrasound method of direct analysis of the speed of blood flowing in the intracranial brain arteries. It finds broad application in diagnosing vascular disorders of the cerebrum, providing information on how passable the brain arteries and veins are, does the collateral blood circulation work well, and if there is vascular pathology (arteriovenous malformation, brain aneurysms, pathological vasospasm, some tumours, etc.). It is used to find microembolic signals of various origin, to diagnose brain death – an extremely important field. One of its latest applications is in the modern treatment of acute ischemic brain insult by applying thrombolysis (breaking down of blood clots in the artery by pharmacological means).

In 2005 on my initiative the Bulgarian Society of Neurosonology and Cerebral Hemodynamics was founded, a non-profit association whose president I am. The aim of the Society is to provide Bulgarian healthcare with highly qualified and world-certified specialists in neurosonology. One of their major medical-social tasks will be to identify the Bulgarians threatened by brain stroke through ultrasound screening and by early diagnosing of cerebral arteriosclerosis to start adequate and timely primary prophylaxis and treatment.

The Society publishes its periodical journal Neurosonology and Cerebral Hemodynamics, it has a website www.neurosonology-bg.com, and in 2008 it published the first bilingual Bulgarian-English Atlas of Neurosonology, authored by eminent neurosonologists from Bulgaria, Austria and Germany.

The Society’s activity is highly appreciated by the international neurosonology organizations. Evidence of this is the fact that the clinic I head has been nominated as research base of the European Federation of Neurological Societies and my election as a member of the Executive Committee of the Neurosonology Research Group of the World Federation of Neurology for the period 2009–2013.

As an expert on the human brain, what do you think about the psychics, demonstrating paranormal abilities, so fashionable lately? Are there objective methods of analysis, which confirm these abilities? Do you believe that in time people will unfold them and they will become mass practice, as some hypotheses hold?
Paranormal abilities exist in as far as contemporary science cannot explain them. Some can be objectified but most of them are perceived as “mysterious” phenomena. A proof that man can develop “superabilities” are patients who have lost specialized senses – vision, hearing. In time they compensate for this defect by heightened sensitivity of their other senses and learn how to find their bearings in space unassisted. Remember the phenomenon Vanga? She developed her psychic abilities after she suffered a complete loss of vision. There are many such cases and they often provide subject matter for movies.

A good example of superability is telekinesis (the ability to act upon inanimate objects by the force of will) and the psychophysical phenomena – clairvoyance, telepathy, proscopy, etc. which were practiced by the mystic yogis in antiquity. Some researchers hold that these effects are achieved by the formation of powerful physical fields, while others believe it is done by mental effort (psychokinesis). It is noted that these parapsychological abilities sometimes appear in the wake of traumas, diseases, stress, electric shock. This confirms the existence of hidden potentials in the human body and the brain, which are today associated with the processes of “brain reorganization” occurring as the result of a strong external or internal physiological or morbid stimulus. Contemporary scientists agree that the mind can affect the physical, biological and psychological processes and this can be cultivated. Some believe that every man is endowed with “paranormal” capacities, which under normal conditions remain latent. For the time being we can only say that there exists a “peculiar” psychoenergy which under certain circumstances is manifested and becomes “paranormal.” Future research will show whether these processes are really “paranormal,” and if so, to what extent they can be universal and whether they are subject to perfection.

You are a woman and probably nothing female is foreign to you. What are your female preferences (or weaknesses) colouring your life? Do you have plans for the future? And are they associated with Bulgaria?
I like the beauty of fashion, elegance, style. I try to always have something trendy and even extravagant in my garments. As a young woman I made my own clothes, I knitted pullovers, I stitched gobelins, wrote verses. Now I prefer ready-made clothes, especially designer’s. I scarcely have time for poetry. At the same time, altruism is still alive in me and I think it will never leave me. I have no cardinal plans for the future. As you know, the future may hold great surprises. I have a couple of big scientific ideas, which I intend to realize. I like my work and life in Bulgaria and I want to continue living here. My trips abroad are short and most often related to my scientific engagements as participant in international forums. The more I see of the world, however, the more convinced I become that Bulgaria is a wonderful country, which needs its people to learn to protect and love it better.