Advances in the diagnosis and management of post-stroke limb spasticity: a narrative review

Objective: This review aims to provide a comprehensive overview of the current understanding and clinical management of post-stroke limb spasticity. Methods: Literature searches were conducted in PubMed and CNKI databases for articles published between January 2000 and June 2025, using keywords related to post-stroke spasticity, assessment, and interventions (botulinum toxin, rehabilitation, neuromodulation, surgery). The search was restricted to English-language articles addressing post-stroke limb spasticity. After screening, 68 studies were included and categorized by research theme. Results: Several interventions were identified as effective in alleviating post-stroke limb spasticity. Specifically, botulinum toxin injection has emerged as the primary choice for managing focal spasticity. Neuromodulation methods, including transcranial magnetic stimulation, transcranial direct current stimulation, spinal cord stimulation, and vagus nerve stimulation, demonstrated significant therapeutic potential. Conclusion: Neuromodulation techniques exert their effects by adjusting corticospinal tract excitability and promoting neural plasticity. However, additional randomized controlled trials are necessary to optimize stimulation settings and confirm their long-term effectiveness.