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rTMS alleviates post-stroke spasticity and improves motor function in patients with upper limb involvementMagnetic stimulation helps manage muscle stiffness after a stroke

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Key Takeaway
Consider rTMS to reduce post-stroke spasticity and improve motor function, especially in upper limb cases.

This meta-analysis synthesized data from 13 studies involving 18 RCTs to evaluate the efficacy of repetitive transcranial magnetic stimulation (rTMS) for post-stroke spasticity (PSS). The analysis found that rTMS significantly alleviated PSS (MD = -0.23; 95% CI: -0.43 to -0.02, P = 0.03). Furthermore, motor function improved significantly (MD = 2.46; 95% CI: 1.54 to 3.38, P < 0.00001), with even greater improvements observed in patients with upper limb PSS (SMD = 3.58; 95% CI: 2.18 to 4.98, P < 0.00001).

Specific technical parameters influenced outcomes. Stimulating the unaffected hemisphere was significantly more effective for spasticity (SMD = -0.19; 95% CI: -0.37 to -0.00, P = 0.05), and combined high and low frequency rTMS showed promising effects (SMD = -0.65; 95% CI: -0.94 to -0.36, P < 0.00001). Additionally, pulse number was positively correlated with motor improvement (beta = 2.46; 95% CI: 0.097 to 4.81, P = 0.043).

Evidence for improving activities of daily living (ADL) is currently insufficient due to very low quality evidence (SMD = 0.31; 95% CI: -0.06 to 0.67, P = 0.10). These findings suggest that while rTMS is effective for spasticity and motor function, clinical optimization should consider stimulation site, frequency, and pulse number.

How this fits prior evidence

This meta-analysis extends prior evidence showing that transcranial magnetic stimulation improves upper limb function and motion in post-stroke patients. Specifically, it adds quantitative data regarding the reduction of spasticity (MD = -0.23) and identifies specific moderators such as stimulation site (unaffected hemisphere) and pulse number as factors influencing motor outcomes.

Living with the muscle stiffness, known as spasticity, that often follows a stroke can make daily movements difficult. New research looks at how repetitive transcranial magnetic stimulation (rTMS) helps patients manage this condition. This treatment uses magnetic pulses to stimulate the brain and may help relax stiff muscles.

A review of 18 clinical trials found that rTMS successfully reduced spasticity and improved motor function, especially in those with upper limb issues. The study also noted that targeting the unaffected side of the brain was more effective than other methods. Additionally, using a mix of high and low frequency pulses showed promising results for patients.

While the treatment shows clear benefits for muscle movement, the evidence is not yet strong enough to say if it helps with daily activities like dressing or eating. Because the data on daily tasks is limited, doctors can use these findings to better tailor the timing and location of magnetic pulses to help patients move more freely.

What this means for you:
Magnetic brain stimulation helps reduce muscle stiffness and improve movement for stroke survivors.

Common questions

What is rTMS and how does it help with stroke recovery?

rTMS stands for repetitive transcranial magnetic stimulation. It uses magnetic pulses to stimulate the brain. In this study, rTMS was found to alleviate spasticity (muscle stiffness) and improve motor function in patients who suffered a stroke.

Does this treatment help with daily activities?

The evidence for whether rTMS helps with activities of daily living is currently not clear. Because the quality of evidence for these specific tasks is very low, it is not yet confirmed if the treatment improves daily routines.

Are there specific ways to make the treatment more effective?

The study suggests that certain factors can improve results. Stimulating the unaffected side of the brain, using a combination of high and low frequency pulses, and increasing the number of pulses within a certain range all showed better outcomes for patients.

Study Details

Study typeMeta analysis
EvidenceLevel 1
PublishedJul 2026
View Original Abstract ↓
OBJECTIVE: This study aimed to investigate the efficacy of repetitive transcranial magnetic stimulation (rTMS) for improving spasticity, motor function, and activities of daily living (ADL) in patients with post-stroke spasticity (PSS), and to perform a comprehensive analysis of key factors related to its therapeutic effect. METHODS: Relevant randomized controlled trials (RCTs) were retrieved from four databases. Meta-analysis was conducted using RevMan, and the quality of evidence was assessed with the GRADEpro tool. RESULTS: Overall, 13 studies (encompassing 18 RCTs) were included. The results demonstrated that rTMS alleviated PSS (MD = - 0.23, 95% CI: -0.43 to - 0.02, P = 0.03) and improved motor (MD = 2.46, 95% CI: 1.54 to 3.38, P < 0.00001), whereas it showed no significant effect on ADL (SMD = 0.31, 95% CI: -0.06 to 0.67, P = 0.10). For spasticity, stimulating the unaffected hemisphere achieved significantly better efficacy (SMD = -0.19, 95% CI: -0.37 to -0.00, P = 0.05), and combined high and low frequency rTMS showed promising effects (SMD = -0.65, 95% CI: -0.94 to -0.36, P < 0.00001). For motor function, rTMS yielded greater improvement in upper limb PSS patients (SMD = 3.58, 95% CI: 2.18 to 4.98, P < 0.00001). Within a certain range, pulse number was positively correlated with motor improvement (β = 2.46, 95% CI: 0.097 to 4.81, P = 0.043). CONCLUSION: Moderate to high quality evidence demonstrates that rTMS can potentially alleviate PSS and improve motor function in patients, whereas its efficacy in improving ADL remains unclear, with very low quality of evidence. In addition, stimulation frequency, stimulation site, pulse number, and affected site are key moderators of rTMS efficacy. These findings guide the clinical optimization of rTMS regimens, and future research is required to identify specific parameter thresholds.
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