Herbal-derived bioactive compounds in stroke recovery: from neuroprotective mechanisms to clinical evidence and translational challenges

Abstract

Stroke is a leading cause of death and long-term disability worldwide, driven by pathophysiological processes including excitotoxicity, oxidative stress, neuroinflammation and apoptosis. Current pharmacological and non-pharmacological interventions primarily restore perfusion or support rehabilitation but do not fully address multifactorial secondary injury. Herbal-derived bioactive compounds possess antioxidant, anti-inflammatory and neuroprotective activities. Preclinical studies show that they limit neuronal injury and modulate excitotoxicity, oxidative stress, neuroinflammation, apoptosis, blood–brain barrier disruption and angiogenesis. Clinical trials suggest that these compounds can complement conventional treatment and improve functional or cognitive outcomes. This review synthesizes evidence on their mechanisms of action, therapeutic roles, combination strategies and research gaps. Herbal-derived bioactive compounds offer accessible adjuncts for stroke management, but their safe and effective integration into rehabilitation practice requires formulation standardization and large-scale clinical trials.