Neuroplasticity Biomarkers and Neurotransmitter Modulation in Post-Ischemic Stroke Rehabilitation: A Narrative Review

Background/Objectives: Recovery after stroke is a complex process involving structural and functional reorganization of the nervous system. Neuroplasticity plays a key role in functional recovery, while biomarkers and neurotransmitter systems may reflect or modulate the biological processes underlying rehabilitation and adaptation after stroke. The aim of this review was to summarize the current evidence regarding biomarkers of neuroplasticity and neurotransmitter modulation in post-stroke rehabilitation, with a particular focus on their potential importance for functional recovery and rehabilitation outcomes. Methods: This narrative review synthesized evidence identified through searches of PubMed/MEDLINE, Scopus, and Web of Science, supplemented by reference-list screening. The literature was qualitatively analyzed according to the main themes of the review. Results: Current data point to BDNF, VEGF, and MMPs as promising biomarkers associated with post-stroke neuroplasticity and functional recovery. Neurotransmitter modulation, particularly involving GABA, glutamate, dopamine, and serotonin, may influence neuronal excitability, synaptic plasticity, and motor learning after stroke. The combination of biomarker assessment and rehabilitation-based modulation of these pathways may provide a more comprehensive approach to understanding and monitoring post-stroke recovery. Conclusions: Current evidence supports the role of neuroplasticity-related biomarkers and neurotransmitter modulation as potential tools for understanding biological responses to post-stroke rehabilitation. However, their clinical relevance and usefulness in guiding individualized rehabilitation require further validation in future clinical studies.