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rTMS interventions significantly reduce modified Ashworth Scale scores for post-stroke limb spasticityMagnetic brain stimulation helps reduce muscle stiffness after stroke

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Key Takeaway
Consider rTMS as a promising adjunctive therapy to reduce limb spasticity following stroke.

This systematic review and meta-analysis evaluated the efficacy of repetitive transcranial magnetic stimulation (rTMS) for managing limb spasticity in post-stroke patients with a baseline modified Ashworth Scale (MAS) score of 1 or greater. The analysis included both conventional rTMS and patterned protocols, such as continuous and intermittent theta-burst stimulation (cTBS/iTBS).

The meta-analysis reported that rTMS interventions significantly reduced MAS scores compared to control groups, with a pooled effect size of -0.51 (95% CI: -0.66 to -0.36, p < 0.00001). These results were consistent across different stimulation protocols, target areas, and stages of stroke recovery.

While the meta-analysis indicates that rTMS is a promising adjunctive intervention for limb spasticity, it noted that no significant effect of the total number of treatment pulses on therapeutic outcomes was identified. The findings suggest clinical utility regardless of specific pulse volume or whether conventional or theta-burst protocols are utilized.

How this fits prior evidence

This meta-analysis addresses a gap in non-pharmacological management for post-stroke physical symptoms. While prior coverage noted that mind-body training improves upper-limb function and acupuncture shows signals for dysphagia and depressive symptoms, this study provides specific evidence for rTMS as an intervention for limb spasticity. It complements existing evidence for multi-modal rehabilitation by providing a statistically significant reduction in MAS scores (effect size -0.51).

Living with the aftermath of a stroke often involves dealing with stiff, tight muscles known as spasticity. This physical limitation can make daily movements difficult and uncomfortable for patients. New research highlights a promising way to manage this condition using repetitive transcranial magnetic stimulation (rTMS).

Researchers analyzed several trials and found that rTMS significantly reduced muscle stiffness scores compared to standard care. The study looked at various types of magnetic pulses, including both conventional methods and faster patterned protocols like theta-burst stimulation. These results suggest the treatment is effective regardless of the specific pulse type or the stage of recovery after a stroke.

While the data shows consistent success in reducing muscle tension, it is important to note that the total number of pulses delivered did not change how well the treatment worked. Because this was a review of existing trials, individual results may vary based on personal health factors. Patients should speak with their doctors to see if this specific magnetic therapy is a good fit for their recovery plan.

What this means for you:
Magnetic brain stimulation (rTMS) effectively reduces muscle stiffness in patients following a stroke.

Common questions

What is rTMS and how does it help after a stroke?

rTMS stands for repetitive transcranial magnetic stimulation. It uses magnetic pulses to target the brain. In this study, it was found to significantly reduce muscle stiffness (spasticity) in patients who had suffered a stroke, regardless of which specific type of pulse_protocol was used.

Does the number of pulses matter for treatment success?

The study found that the total number of treatment pulses did not have a significant effect on how well the therapy worked. The primary goal is reducing muscle stiffness, and rTMS was shown to be effective across different stimulation methods.

Is this treatment effective for all stages of stroke recovery?

Yes, the evidence suggests that rTMS is a promising way to manage limb stiffness at various stages of recovery after a stroke. It showed consistent results whether patients were in early or later stages of their rehabilitation.

Study Details

Study typeMeta analysis
EvidenceLevel 1
PublishedJun 2026
View Original Abstract ↓
BACKGROUND: Post-stroke spasticity significantly impairs motor function in patients. Repetitive transcranial magnetic stimulation (rTMS), including conventional rTMS and its patterned protocols such as continuous and intermittent theta-burst stimulation (cTBS/iTBS), has been widely investigated as a promising noninvasive neuromodulation technique to promote motor recovery after stroke. However, the efficacy of rTMS in treating post-stroke spasticity remains unclear. Therefore, this study aims to evaluate the therapeutic effects of rTMS on post-stroke spasticity through a meta-analysis. METHODS: A comprehensive search was conducted for randomized-controlled trials (RCTs) published between January 1, 2010, and July 1, 2025, in the Embase, Cochrane Library, and PubMed databases. The inclusion criteria were post-stroke patients with a baseline modified Ashworth Scale (MAS) score of ≥ 1, indicating the presence of spasticity. The interventions of interest were repetitive transcranial magnetic stimulation (rTMS) or intermittent/transient theta-burst stimulation (iTBS/cTBS), with the primary outcome measure being the MAS score. Cochran's Q test and the I statistic were used to assess heterogeneity between studies, and a random-effects model was applied for data synthesis. RESULTS: A total of 12 RCTs were included in the analysis. The meta-analysis results demonstrated that, compared to the control group, rTMS interventions significantly reduced the MAS score, with a pooled mean difference (MD) of -0.51 (95% confidence interval [CI]: - 0.66 to - 0.36, p < 0.00001). Sensitivity analysis using the leave-one-out method confirmed the robustness of this result. Subgroup analysis indicated that the therapeutic effects of rTMS were consistent across different stimulation protocols (LF-rTMS, iTBS/cTBS), target areas (contralateral M1 region, other brain areas), and stages of stroke (subacute, chronic). Meta-regression analysis revealed that the total number of treatment pulses was not a significant source of heterogeneity, nor was it significantly correlated with treatment efficacy. CONCLUSIONS: rTMS is a promising adjunctive intervention for post-stroke limb spasticity, with its efficacy confirmed across various stimulation parameters and patient populations. However, no significant effect of the total number of treatment pulses on therapeutic outcomes was identified.
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