Biomarkers of Motor Recovery After Corticospinal Tract Damage in Stroke: A Scoping Review

Motor recovery after stroke is highly variable and closely linked to the extent of corticospinal tract (CST) damage. Neurophysiological biomarkers, such as motor evoked potentials (MEPs) and structural imaging markers, including CST lesion load and fractional anisotropy (FA), show promise for predicting motor outcomes. This scoping review evaluated the prognostic value of these biomarkers and the utility of multimodal models for individualized rehabilitation. A systematic search (April 2024) in PubMed, the Cochrane Library, and Scopus identified empirical studies examining biomarkers predictive of post-stroke motor recovery. Biomarkers were primarily derived from magnetic resonance imaging (resting-state functional connectivity and diffusion-weighted imaging) and transcranial magnetic stimulation. Nineteen studies (1219 patients) met the inclusion criteria. Structural biomarkers, particularly lower CST FA and higher weighted lesion load, were generally associated with poorer motor recovery. Combining neurophysiological measures, such as MEP status, with functional imaging and artificial intelligence-based analyses may improve prognostic precision. Multimodal approaches appeared promising in some studies, but evidence remains limited and heterogeneous. Integrating diverse biomarkers into multimodal prognostic models may enhance the prediction of motor recovery and support personalized rehabilitation after stroke, although heterogeneity in study design and outcome assessment highlights the need for standardized, large-scale longitudinal studies to enable clinical implementation.