Electroacupuncture Modulates Multiple Pathways for Neuroprotection and Neurorepair in Ischemic Stroke

BACKGROUND: The complex pathophysiology of ischemic stroke (IS) involves initial injury followed by secondary cascades and endogenous repair. This review systematically explores how electroacupuncture (EA) precisely modulates these processes. METHODS: We systematically searched and summarized all papers related to EA treatment for stroke using the China National Knowledge Infrastructure (CNKI) and PubMed databases. RESULTS: We detail EA's key mechanisms in reducing initial and secondary damage, including the suppression of inflammatory responses (e.g., NF-κB, inflammasomes, gut-brain axis), mitigation of oxidative stress (Nrf2/HO-1), attenuation of excitotoxicity (NMDAR, GLT-1), and inhibition of diverse forms of regulated cell death (apoptosis, pyroptosis, ferroptosis). Critically, EA also actively promotes vital repair mechanisms by enhancing cerebral blood flow, protecting blood-brain barrier integrity, promoting angiogenesis (VEGF, HIF, Notch, Wnt pathways), and fostering extensive neural regeneration and plasticity (neurogenesis, neurotrophic factors, myelination, synaptic changes, network reorganization) at molecular, cellular, and network levels. These well-documented mechanistic actions provide a strong scientific basis for the observed clinical benefits of EA in improving major poststroke sequelae, encompassing motor, cognitive, language, and emotional deficits. CONCLUSIONS: The review highlights the potential for enhanced outcomes through combined therapy approaches and identifies future research avenues leveraging advanced technologies like multi-omics and AI for personalized precision EA. EA stands as a scientifically grounded, multi-target therapy improving stroke recovery.