# Repetitive transcranial magnetic stimulation for post stroke rehabilitation—a single center community experience

## TL;DR

This study shows that rTMS combined with physiotherapy helps some stroke patients recover, with better results when treatment starts sooner and when both sides of the brain are stimulated.

## Contribution

The study provides new insights into the effectiveness of bilateral rTMS and the importance of early treatment in post-stroke rehabilitation.

## Key findings

- 70% of patients improved significantly in one or more measurements after rTMS and physiotherapy.
- Bilateral stimulation was 2.8 times more likely to result in improvement compared to unilateral stimulation.
- Earlier treatment initiation was associated with better outcomes (p = 0.027).

## Abstract

Repetitive transcranial magnetic stimulation (rTMS), a form of non-invasive neuromodulation, has been shown to improve recovery post stroke. The definitive mechanism by which it alleviates symptoms remains elusive and as such many questions as to how to predict and improve clinical response are left unanswered. We conducted a retrospective chart review of our experience using rTMS combined with physiotherapy in post stroke patients at our clinic between 2014 and 2025. We reviewed 35 charts and found 23 that qualified. The mean age was 59.6 years, 57 percent male. Overall, 70 percent improved significantly in one or more measurements. Patients who received bilateral stimulation were 2.8 (95 percent confidence interval 1.4–7.8) times more likely to improve compared to patients who received unilateral stimulation. The mean time from the stroke to treatment in the improved group was 13.1 (4–35) months while in the unimproved group was 33.3 (5–80) months (p = 0.027). We found that rTMS combined with physiotherapy is effective in chronic post stroke patients. Time between the stroke and the beginning of treatment is inversely related to rTMS response and bilateral stimulation is more effective than unilateral stimulation.