"Investigating Reliable Recovery Biomarkers of Ischemic Stroke: An Evidence-Based Study"

In 2020, WHO reported that stroke is the second leading cause of death worldwide. Stroke recovery is the complex process due to its heterogeneous nature. Identification of reliable recovery biomarkers assist to advance the practice, rehabilitation and recovery after stroke. Objective: This systematic review aimed to assess the biomarkers and predictors of recovery in ischemic stroke. Methods: Case-control studies reporting the biomarkers and predictors of recovery in ischemic stroke patients were identified through PubMed, Wiley online library, Rehab data and PEDro databases. Studies in English language published after the year 2000 were included. Studies on animal models and patients with other psychiatric or neurological condition (other than stroke) were excluded. The Newcastle-Ottawa Scale (NOS) was used to assess the quality of studies. Relative levels of recovery biomarkers in post-ischemic stroke patients were compared with the levels found in control subjects. Random effect model was used to calculate the mean effect size of studies. This systematic review was registered with PROSPERO (CRD42020209833). The results of this systematic review are based on 29 studies that covered 2528 participants (case:926 patients, control:1602 participants). A total of 22 markers were reported in this review. The core biomarkers differentiated ischemic stroke’s recovery from controls with good performance: Motor evoked potential [standardized mean difference -2.14, P=0.03], laterality index [standardized mean difference -1.32, P=0.03] and stimulus intensity [standardized mean difference 1.63, P=0.18]. Conclusion: The motor evoked potential, laterality index and stimulus intensity were found as relevant biomarkers that predict motor recovery in ischemic stroke patients.