Neural Repair Therapies After Stroke: I. Therapeutic Advances

Stroke is a leading cause of disability worldwide. Neural repair therapies, distinct from acute stroke therapies, target surviving neural elements to promote plasticity after the acute injury has occurred. Repair therapies encompass a broad and rapidly evolving therapeutic landscape, ranging from behavioral training, drugs, and biological agents to neural stimulation. In this review, we highlight major advances across these therapeutic categories, focusing on the evidence base and readiness for clinical adoption. Intensive behavioral interventions, including constraint-induced movement therapy and telerehabilitation, result in meaningful gains even in chronic stroke. Biological therapies-growth factors, monoclonal antibodies, and stem cell approaches-show promise but face translational challenges. Pharmacological strategies targeting serotonergic and dopaminergic systems have yielded mixed results. Neural stimulation approaches span a spectrum of invasiveness, with vagus nerve stimulation now Food and Drug Administration-approved and emerging candidates including cerebellar deep brain stimulation and spinal cord epidural stimulation showing early promise. These studies have provided important lessons for neural repair trial design. Synthesizing evidence across modalities, we highlight how therapeutic advances are reshaping the landscape of poststroke recovery and identify the most promising opportunities for clinical translation. Emerging neural repair strategies stand to substantially improve function after stroke.