Deans' stroke musings: Biomarkers associated with functional improvement after stroke rehabilitation: a systematic review and meta-analysis of randomized controlled trials

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Thursday, September 7, 2023

Biomarkers associated with functional improvement after stroke rehabilitation: a systematic review and meta-analysis of randomized controlled trials

Biomarkers are useless for survivors; all they do is predict failure to recover.

Biomarkers associated with functional improvement after stroke rehabilitation: a systematic review and meta-analysis of randomized controlled trials

Gengbin Chen^1,2

Manfeng Wu¹

Jialin Chen²

Cailing Zhang¹

Quan Liu²

Yinchun Zhao²

Guangqing Xu³^*

Yue Lan^1,4^*

¹Department of Rehabilitation Medicine, Guangzhou First People’s Hospital, School of Medicine, South China University of Technology, Guangzhou, China
²Postgraduate Research Institute, Guangzhou Sport University, Guangzhou, China
³Department of Rehabilitation Medicine, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
⁴Guangzhou Key Laboratory of Aging Frailty and Neurorehabilitation, Guangzhou, China

Objective: This study aims to identify blood and cerebrospinal fluid biomarkers that are correlated to the functional improvement of stroke patients after rehabilitation therapy, and provide ideas for the treatment and evaluation of stroke patients.

Methods: The PubMed, Web of Science, and Embase databases were searched for articles published in the English language, from inception to December 8, 2022.

Results: A total of 9,810 independent records generated 50 high-quality randomized controlled trials on 119 biomarkers. Among these records, 37 articles were included for the meta-analysis (with a total of 2,567 stroke patients), and 101 peripheral blood and cerebrospinal fluid biomarkers were included for the qualitative analysis. The quantitative analysis results revealed a moderate quality evidence that stroke rehabilitation significantly increased the level of brain-derived neurotrophic factor (BDNF) in serum. Furthermore, the low-quality evidence revealed that stroke rehabilitation significantly increased the concentration of serum noradrenaline (NE), peripheral blood superoxide dismutase (SOD), peripheral blood albumin (ALB), peripheral blood hemoglobin (HB), and peripheral blood catalase (CAT), but significantly decreased the concentration of serum endothelin (ET) and glutamate. In addition, the changes in concentration of these biomarkers were associated with significant improvements in post-stroke function. The serum BNDF suggests that this can be used as a biomarker for non-invasive brain stimulation (NIBS) therapy, and to predict the improvement of stroke patients.

Conclusion: The concentration of serum BNDF, NE, ET and glutamate, and peripheral blood SOD, ALB, HB and CAT may suggest the function improvement of stroke patients.

Introduction

Stroke is the leading cause of death in China, and the second leading cause of death worldwide (1, 2). Surviving a stroke can lead to a series of sequelae, such as post-stroke motor deficits, sensory deficits, cognitive deficits, and other dysfunctions, increasing the global medical burden (3–6). Rehabilitation plays an essential role in the functional recovery of post-stroke patients (7). To date, a number of general scales and instruments (National Institute of Health Stroke Scale, Barthel index, etc.) have been introduced worldwide to evaluate the recovery of extrinsic function (motor function, cognitive function, speech function, etc.) of stroke patients (8). However, relatively few studies (9, 10) have evaluated the intrinsic physiological mechanism of recovery (improvement of neural repair and protection of brain tissues) of stroke patients, in order to predict possible treatment targets through changes in blood and cerebrospinal fluid components, before and after intervention. Furthermore, since relevant evidences have not been summarized by any published literature, it remains difficult to determine whether the changes in biomarkers can predict the functional improvement or deterioration of stroke patients.

In order to provide the possibility of developing biomarkers for improved function in stroke rehabilitation, and put forward specific therapeutic targets, the present study conducted a meta-analysis and systematic evaluation of evidence-based treatments, and documented the presence or absence of biomarkers that show evidence of replication. The present study aims to identify biomarkers associated with functional improvement after the rehabilitation of stroke patients.