The role of repetitive transcranial magnetic stimulation in restoration of post stroke motor power

Abstract

Stroke causes long-term disability, and rTMS—by modulating cortical excitability and promoting neuroplasticity—may enhance post-stroke motor recovery. To investigate the effect of rTMS on motor outcome in acute ischemic stroke (AIS) patients admitted within two weeks of onset and to compare high- and low-frequency rTMS effects on motor recovery. This prospective cohort study included 99 male patients with acute ischemic stroke, consecutively recruited between July 2020 and September 2023 at the Stroke Unit, Kobri El-Koba Military Medical Complex. Patients were non-randomly assigned (1:1:1) to high-frequency rTMS, low-frequency rTMS, or sham control. rTMS was delivered in five consecutive daily sessions per month for three months (15 sessions total); high-frequency (10 Hz) was applied over the affected primary motor cortex, and low-frequency (1 Hz) over the unaffected motor cortex. Baseline demographics, stroke severity (NIHSS), motor power (MRC), and functional outcome (mRS) were recorded at baseline and monthly for three months. Stroke patients receiving rTMS showed significantly greater neurological and motor recovery than controls. Although baseline severity was comparable, both HF and LF rTMS improved NIHSS, MRC, and mRS scores over follow-up, with the greatest effects observed in the HF group. Recovery was mainly driven by rTMS rather than lesion side or site, supporting its role in enhancing post-stroke recovery. Early rTMS enhances neurological and motor recovery in acute ischemic stroke, with high-frequency rTMS being most effective, independent of lesion characteristics.