Role of biomarkers in stroke neurorehabilitation – an important tool to help predict recovery

Abstract

Stroke is a leading cause of disability, especially in the Indian subcontinent. While rehabilitation promotes recovery through neuroplasticity and motor learning, individual factors like biomarkers are gaining attention for their predictive value. Genetic markers such as Brain Derived Neurotrophic Factor (BDNF), Catecholo-Methyltransferase (COMT), and Apolipoprotein E (APOE) influence recovery, with BDNF Val66Met linked mainly to poorer upper limb motor outcomes. Neurophysiological and imaging biomarkers, including motor evoked potentials and diffusion-weighted magnetic resonance imaging (MRI), help predict motor recovery and inform tools like the predict recovery potential 2 (PREP2) algorithm. Blood-based biomarkers, particularly those in the kynurenine pathway, are associated with cognition and post-stroke depression, offering potential treatment insights through repetitive transcranial magnetic stimulation (rTMS). Overall, biomarkers may enable more personalized rehabilitation, but larger, context-specific studies are needed to confirm their role across motor, language, and cognitive recovery.