Electroencephalography and Electromyography as a Non-Invasive Biomarker of Neural Regeneration: A Review of Central and Peripheral Nervous System Injury and Regeneration
Regeneration of the nervous system after injury remains an important therapeutic objective, especially in the central nervous system (CNS), in which regeneration is restricted by both neuronal limitations as well as adverse extracellular environments. Conversely, the peripheral nervous system (PNS) displays enhanced regenerative capability in the presence of supportive Schwann cells (SC) and pro-growth stimuli. While the structure and molecular mechanisms are thoroughly understood, functional biomarkers that can non-invasively monitor regeneration in real time are limited. In this review, we discuss the promise of electroencephalography (EEG) as well as electromyography (EMG) as real-time, non-invasive biomarkers to monitor damage to nerves and regeneration in both CNS and PNS contexts. First, we contrast biological and electrophysiological indicators of CNS/PNS injury, showing how EEG signs, including oscillatory power, connectivity, and evoked potential changes, reflect dysfunction due to injury as well as neuroplastic reorganization. Also, EMG provides direct insight into muscle activation and peripheral output, providing useful EEG complementation in neuromuscular pathway integrity and reactivation. In CNS injuries (e.g., stroke, spinal cord injury (SCI)), EEG typically shows global slowing, disrupted interhemispheric coherence, and partial recovery of higher frequencies. For PNS injuries, EEG can capture cortical remapping and return of somatosensory evoked responses with re-establishment of the peripheries' connectivity. EMG, in turn, enables monitoring of reinnervation and restoration of functional motor output. This review presents a dual-system perspective, positioning EEG and EMG not only as diagnostic tools but also as functional biomarkers of neural regeneration, thereby bridging electrophysiology, plasticity, and clinical recovery.