Serum BDNF levels as a potential prognostic marker for functional recovery in stroke: Preliminary findings from a prospective observational study

Prognistication DOES NOTHING FOR SURVIVOR RECOVERY! Are you really that blitheringly stupid? Can you even get dressed in the morning?

 Serum BDNF levels as a potential prognostic marker for functional recovery in stroke: Preliminary findings from a prospective observational study

 Seyoung Shin 1, 

Heegoo Kim 1, 

Dae Hyun Kim 2, 

Won Hyuk Chang 2,3* 

1 Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea, 

2 Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea, 

3 Department of Health Science and Technology, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea * wh.chang@samsung.com, iamchang@skku.edu 

Abstract 

Brain-derived neurotrophic factor (BDNF) crosses the blood-brain barrier and may serve as a marker of neuroplasticity. This study evaluated whether serum levels of mature BDNF, proBDNF, and matrix metalloproteinase-9 (MMP-9) can predict functional recovery after stroke. In this prospective observational study, 93 patients with unilateral stroke and motor impairment were recruited. Clinical, and demographic data, as well as serum levels of mature BDNF, proBDNF, and MMP-9 were col lected. Functional assessments measuring stroke severity, cognition, motor function, balance, and mood were conducted at three timepoints: after acute care (T0), 2 weeks post-rehabilitation (T1), and 3 months post-onset (T2). Mature BDNF signifi cantly decreased from T0 to T2 (p = 0.003), while proBDNF remained stable. MMP-9 declined consistently across timepoints (p < 0.001). MMP-9 levels at baseline dif fered by BDNF genotype (p < 0.05). However, none of the biomarkers independently predicted functional recovery. Functional outcomes improved significantly over time (p < 0.001), with baseline functional scores being the strongest predictors at T1 and T2. Although these biomarkers were not independent predictors of recovery, their longitudinal trajectories may reflect underlying neurobiological recovery mechanisms during rehabilitation, although their prognostic utility remains inconclusive

Breaking Down the 2026 Acute Ischemic Stroke Guidelines

 What a FUCKING SHITSHOW! Guidelines; NOT PROTOCOLS! Doesn't anyone in stroke have a functioning brain?

Send me personal hate mail on this: oc1dean@gmail.com. I'll print your complete statement with your name and my response in my blog. Or are you afraid to engage with my stroke-addled mind? No excuses are allowed! You're medically trained; it should be simple to precisely state EXACTLY WHY you aren't working on 100% recovery protocols with NO EXCUSES! I've never received any communications from any stroke association. You'd think they would want to talk to their fiercest critic, but no, they are hiding under a rock someplace, probably don't even know I exist! Swearing at me is allowed, I'll return the favor. Don't even attempt to use the excuse that brain research is hard.

Breaking Down the 2026 Acute Ischemic Stroke Guidelines

Andrei Alexandrov, MD, an award-winning leader in stroke research and clinical care, discussed the clinical impact of the latest stroke guidelines and their implications for diagnosis and care.

Acute ischemic stroke (AIS) occurs when a cerebral artery becomes suddenly occluded, leading to interruption of blood flow and oxygen delivery to brain tissue. It accounts for approximately 85% of all strokes and represents a neurologic emergency in which rapid diagnosis and treatment are critical to preserving brain function and reducing long-term disability.¹

The recently published stroke guidelines, developed and maintained by the American Heart Association in collaboration with its stroke-focused division, the American Stroke Association, were written by experts in vascular neurology, emergency medicine, neurointervention, neurosurgery, neuroradiology, and rehabilitation medicine. Final documents underwent peer review and were published in the journal Stroke to support evidence-based stroke care across diverse health care settings.²

The updated stroke guidelines span the full continuum of acute ischemic stroke care, from prehospital triage and selection of intravenous thrombolytic agents to refined criteria for mechanical thrombectomy and post-procedural management. They clarify indications for tenecteplase and basilar artery thrombectomy, offer more cautious guidance for medium and distal vessel occlusions, and introduce structured recommendations for pediatric stroke and post-stroke dysphagia treatment. In addition to informing real-world clinical decision-making, the guidelines identify ongoing gaps in areas such as blood pressure management after reperfusion and device optimization, helping to shape future clinical trials and innovation in stroke systems of care.

As part of ongoing coverage, NeurologyLive® spoke with Andrei Alexandrov, MD, an award-winning leader in stroke research and clinical care, for an in-depth discussion of the updated guidelines. In this interview, Alexandrov shared key takeaways from the recommendations, examined their implications for everyday clinical practice, and highlighted remaining challenges in post-stroke blood pressure management. He also offered insight into how the revised criteria may shape future research priorities and therapeutic development in the field.

Top Takeaways From the 2026 Stoke Guidelines

Alexandrov explained that the updated 2026 stroke guidelines align formal recommendations with evolving real-world practice. Most notably, tenecteplase (TNK) is now recommended alongside alteplase as an acceptable agent for intravenous thrombolysis, reflecting widespread adoption at advanced stroke centers. The guidelines also formally endorse mobile stroke units for rapid thrombolysis delivery and triage where available, and, for the first time, incorporate structured recommendations for pediatric stroke, including imaging, registry development, and treatment considerations.

Major Takeaways

1. Tenecteplase is now recommended alongside alteplase as an acceptable intravenous thrombolytic agent.
2. Mobile stroke units are endorsed for rapid thrombolysis delivery and triage where available.
3. Pediatric stroke is formally included, with guidance on imaging, registries, and treatment considerations.
4. The guidelines are among the most comprehensive and detailed stroke updates published to date.

Unanswered Questions: Blood Pressure management and Reperfusion injury

Alexandrov noted that optimal blood pressure management after successful reperfusion remains unsettled. Although cerebral hyperperfusion is recognized after thrombectomy, trials of intensive blood pressure lowering have not improved outcomes and may cause harm. The field now faces the challenge of determining whether more individualized and standardized approaches are needed.

Major Takeaways

1. Cerebral hyperperfusion occurs in a substantial subset of patients after successful reperfusion.
2. Intensive blood pressure lowering has not consistently improved outcomes in trials.(Why should it? You're reducing the blood flow and oxygen delivery to the brain when it needs it most to prevent penumbra death! Can't you think at all?)
3. Individualized blood pressure strategies may be preferable to one-size-fits-all approaches.
4. More rigorous and standardized trials are needed to guide post-thrombectomy management.

Expanding the Scope of Stroke Care: Dysphagia and Rehabilitation

('care' NOT RECOVERY! For that alone, you're fired!)

Alexandrov spotlighted guidelines expansion beyond acute reperfusion, highlighting pharyngeal electrical stimulation (PES) as a recommended option for post-stroke dysphagia. With FDA approval supported by European data, this therapy represents a shift toward more active treatment of neurogenic dysphagia rather than relying solely on compensatory measures.

Major Takeaways

1. Pharyngeal electrical stimulation is now recommended for selected patients with post-stroke dysphagia.
2. FDA approval was supported by European data demonstrating safety and efficacy.
3. The guidelines may accelerate adoption of more active dysphagia therapies in US practice.
4. Stroke care continues to expand beyond acute reperfusion to include rehabilitation innovation.

Looking Ahead: A Tool for Practice Change and Future Research

Alexandrov concluded by mentioning that the 2026 update serves both as a consolidation of current evidence and a roadmap for future investigation. It equips clinicians to implement updated protocols while identifying research gaps in thrombectomy expansion, device development, and post-reperfusion management.

Major Takeaways

1. The guidelines can help clinicians advocate for updated institutional protocols.
2. Research gaps are clearly identified, guiding future clinical trials.
3. Mechanical thrombectomy, thrombolysis, and rehabilitation strategies continue to evolve.
4. The 2026 update represents both consolidation of progress and a roadmap for future innovation.

Transcript edited for clarity. Click here to view more of our coverage on Stroke.

REFERENCES
1. American Heart Association / American Stroke Association. 2026 Guideline for the Early Management of Patients With Acute Ischemic Stroke. Published in Stroke. 2026.
2. American Heart Association. Guideline Development Manual. American Heart Association Scientific Statements and Clinical Practice Guidelines Methodology.

Clinical study of repetitive transcranial magnetic stimulation in the rehabilitation of post-stroke depression: A Quantitative Insomnia Sleep Inventory monitoring evaluation

You're that stupid that preventing depression by having 100% recovery protocols is not even in your thought process? My god, you're all fired for incompetency!

 Clinical study of repetitive transcranial magnetic stimulation in the rehabilitation of post-stroke depression: A Quantitative Insomnia Sleep Inventory monitoring evaluation

 Ai-Ming Gu, 

Chao Liu, 

Jian-Hong Chen, 

Ru-Ya Guo, 

Chao Liang, 

Xing-Shi Chen 

Ai-Ming Gu, Department of Neurology, Jiaxing Hospital of Traditional Chinese Medicine, Jiaxing 314000, Zhejiang Province, 

China Chao Liu, Department of Psychiatry, The First Hospital of Jiaxing, Jiaxing 314000, Zhejiang Province, China 

Jian-Hong Chen, Department of Medical, Jinhua City Durg Rehabilitation Isolation Center, Jinhua 321000, Zhejiang Province, China 

Ru-Ya Guo, Department of Endocrinology, The First Hospital of Jiaxing, Jiaxing 314000, Zhejiang Province, China 

Chao Liang, Department of General Practice, The First Hospital of Jiaxing, Jiaxing 314000, Zhejiang Province, China 

Xing-Shi Chen, Department of Electrophysiology, Shanghai Mental Health Center, Shanghai 200030, China ORCID number: Ai-Ming Gu (0009-0006-5409-9052); Chao Liu (0009-0002-3804-7245); Jian-Hong Chen (0009-0004-2333-0632); Ru-Ya Guo (0009-0002-8282-5315); Chao Liang (0009-0006-0072-6153); Xing-Shi Chen (0009-0005-0237-6196). Co-first authors: Ai-Ming Gu and Chao Liu. Co-corresponding authors: Jian-Hong Chen and Ru-Ya Guo. Author contributions: Gu AM and Chen JH designed the study; Gu AM, Guo RY, and Chen XS conducted the research; Chen JH and Chen XS provided experimental instruments; Liu C, Chen JH, and Liang C analyzed the data and drafted the manuscript; Gu AM and Liu C contributed equally to this manuscript and are co-first authors; Chen JH and Guo RY contributed equally to this manuscript and are co-corresponding authors. All authors have read and approved the final manuscript. 

Supported by National Natural Science Foundation of China, No. 81471357; and the Project of Jinhua Municipal Bureau of Science and Technology, No. 2024-07 and No. 2024-08. Institutional review board statement: This study was reviewed and approved by the Medical Ethics Committee of Shanghai Mental Health Center (Approval No. 2019009). Informed consent statement: All participants in the study signed the informed consent form before commencement of the study. Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article. STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items. Data sharing statement: No additional data are available. Corresponding author: Jian-Hong Chen, Department of Medical, Jinhua City Durg Rehabilitation Isolation Center, No. 1 Fangjingtou Community, Fangjingtou Village, Wucheng District, Jinhua 321000, Zhejiang Province, China. 18713190@qq.com Received: November 7, 2025 Revised: December 8, 2025 Accepted: February 5, 2026 Published online: March 19, 2026 Processing time: 111 Days and 23 Hours 

 Abstract 

BACKGROUND Jiaxing Hospital of Traditional Chinese Medicine introduced transcranial magnetic stimulation (TMS) technology in 2019. In practical application, it was found that different types of equipment and technical parameters could lead to differences in therapeutic effects. Therefore, our hospital selected a Danish-made TMS device, which ranked second in the Chinese market, and conducted tests on patients with post-stroke depression (PSD) from March 2019 to September 2023. Before the test, a plan was formulated based on the quality status before and after the inspection. Two evaluators independently controlled the quality of the plan. The repetitive TMS (rTMS) and Quantitative Insomnia Sleep Inventory (QUISI) data were separately stored and verified independently by the two evaluators. AIM To investigate the effect of rTMS and QUISI on the sleep and rehabilitation of patients with PSD. 

METHODS 

From March 2019 to December 2023, subjects who were admitted to the Department of Rehabilitation of the Jiaxing Hospital of Traditional Chinese Medicine, Shanghai Mental Health Center, and National Medical Centre for Psychiatric Disorders were enrolled. A total of 108 patients with PSD were enrolled: 54 patients in the observation group and 54 in the control group. Sixty-eight normal volunteers were also included. Both the observation group and the control group received venlafaxine 150 mg/day sustained-release therapy. The observation group was given venlafaxine combined with rTMS. The control group was treated with venlafaxine combined with rTMS pseudo stimulation. The two groups underwent 42 treatment sessions over 14 weeks. The Hamilton Depression Rating Scale-17 scores were compared between the two groups before and after treatment, and the changes in QUISI were compared with healthy volunteers. 

RESULTS 

The Hamilton Depression Rating Scale-17 scores in the two groups were significantly reduced after treatment, and the improvement was more significant in the observation group (P < 0.05). Before treatment, the sleep latency in the two groups of patients by QUISI was delayed compared to normal volunteers, and the sleep efficiency and maintenance rate were lower than those in normal volunteers, with statistical significance (P < 0.05-0.01). After 14 weeks of treatment, the sleep latency period in the observation group QUISI shifted forward, indicating an increase in sleep efficiency and maintenance rate. The differences between the observation group and the control group were statistically significant (P < 0.01). After a 3-month rehabilitation evaluation, the total effective rate of patients in the observation group was significantly higher than that in the control group (P < 0.05). 

CONCLUSION 

rTMS treatment has a positive effect on PSD in clinical practice. QUISI monitoring can be used for rehabilitation assessment.

Gu AM, Liu C, Chen JH, Guo RY, Liang C, Chen XS. Clinical study of repetitive transcranial magnetic stimulation in the rehabilitation of post-stroke depression: A Quantitative Insomnia Sleep Inventory monitoring evaluation. World J Psychiatry 2026; 16(3): 116094 [DOI: 10.5498/wjp.v16.i3.116094]

Impact of sedentary behavior and physical activity on stroke risk in a cohort of patients with silent brain infarction

 If it is silent, how the hell are you supposed to know to reduce your sedentary time. Described a problem, offered NO solution; USELESS!

Impact of sedentary behavior and physical activity on stroke risk in a cohort of patients with silent brain infarction

• Linxin Bai, 
• Peiyun Zheng, 
• Xiuling Sun, 
• Yuxuan Sun, 
• Zhenxing Guo, 
• Jiahui Gao & 
• Zhizhen Liu 

Scientific Reports , Article number:  (2026) Cite this article

We are providing an unedited version of this manuscript to give early access to its findings. Before final publication, the manuscript will undergo further editing. Please note there may be errors present which affect the content, and all legal disclaimers apply.

Abstract

Silent brain infarction (SBI) is associated with a markedly increased risk of subsequent stroke. Identifying actionable, modifiable risk factors for stroke prevention is essential. Physical activity (PA) is a known protective factor, but the specific impact of sedentary behavior on stroke risk in SBI patients and its interaction with PA remain unclear. This study examines the independent and joint effects of sedentary time (ST) and PA on stroke risk in SBI patients. In this prospective cohort study, we used health check-up data from Chinese hospitals for SBI patients and followed participants for incident stroke. ST and PA were assessed at baseline. The dose–response relationship between ST and stroke risk was evaluated with restricted cubic spline regression. Cox proportional hazards models estimated the independent effects of ST, Moderate-to Vigorous Intensity Physical Activity (MVPA), and their joint effects on stroke risk. Compared with ST < 8 h/day, ST ≥ 8 h/day was associated with a substantially higher risk of stroke (HR, 4.20 [95% CI, 2.23–7.93]); For joint effects, compared with the reference group (ST < 8 h/day & MVPA ≥ 300 min per week (min/wk)), the group with ST ≥ 8 h/day and MVPA ≥ 300 min/week had (HR 3.32 [95% CI 1.11–9.89]). Prolonged sedentary time (≥ 8 h/day) is an independent risk factor for stroke in SBI patients. Engaging in ≥ 300 min/week of MVPA attenuates the adverse association between ST and stroke risk. Reducing sedentary behavior and achieving adequate MVPA may be important for stroke risk management in SBI patients.

Data availability

The datasets generated and/or analyzed during the current study are not publicly available due to the fact that they contain sensitive information that could compromise the privacy of participants. Additionally, the datasets are part of ongoing research projects, and sharing them publicly could interfere with future analyses. However, they are available from the corresponding author upon reasonable request.