Mazandaran Association of Emergency Medicine Translational Health Reports 3092-6750 2 1 2025 12 28 A Narrative Review of Integrative Management for Upper Limb Spasticity After Stroke: The Synergistic Role of Acupuncture and Botulinum Toxin A Monitored Through Biomarkers 237475 10.22034/thr.2025.237475 EN Burhan Tahir Saeed Assistant Professor, Sulaimani Polytechnic University, Iraq 0009-0005-3096-1579 Journal Article Post-stroke upper limb spasticity (PULS) is a disabling condition that severely limits motor function and quality of life. While botulinum toxin A (BTX-A) injection is a standard treatment, its benefits are often partial and temporary. Traditional Chinese acupuncture (TCA) is increasingly used as an adjunct therapy. Concurrently, there is growing interest in identifying objective biomarkers to monitor recovery and elucidate treatment mechanisms.Combining acupuncture with BTX-A is more effective than BTX-A monotherapy for PULS rehabilitation. The therapy induces favorable changes in biomarkers related to muscle repair, neural plasticity, and neuroendocrine adaptation, providing a molecular basis for the observed clinical synergy. This integrated, biomarker-informed approach offers a promising direction for personalized neurorehabilitation in stroke survivors. https://www.threports.com/article_237475_a8f2f836f46f6078b9777523a7d8a5de.pdf