Clinical efficacy evaluation of combined central and peripheral repetitive transcranial magnetic stimulation for elbow flexor (biceps Brachii) spasticity and upper limb motor function after stroke

Starting combined central and peripheral magnetic stimulation earlier was associated with less elbow spasticity and better upper-limb motor scores at three weeks. Differences narrowed after the delayed group also received active treatment.

Liu Q, Yang R, Li D, Wei L, Chu E, Bao Y, Liu Z, Jin L, Xue C, Wang Z.
Frontiers in Neurology · Publication date: 2026-09-25
Added to site: 2026-09-27
DOI: 10.3389/fneur.2026.1868183

Original publication date verified from the publisher and Crossref. This source date is separate from the site's addition date.

Modalities

rTMS, Peripheral magnetic stimulation, EMG

Clinical focus

Stroke, Upper-limb spasticity, Motor rehabilitation

Population

Adults ages 45 to 65 with post-stroke upper-limb spasticity and stroke duration under 6 months

Sample

100 participants randomized 1:1; 50 received active stimulation during weeks 1 to 3 and 50 during weeks 4 to 6

Intervention / method

Fifteen sessions across 3 weeks, each pairing 10 Hz rTMS over affected-side M1, 1,560 pulses, with 1 Hz repetitive peripheral magnetic stimulation at affected-side Erb's point, 1,032 pulses; conventional rehabilitation continued for both groups

Comparator

Delayed-start group received conventional rehabilitation plus sham magnetic stimulation during weeks 1 to 3, then crossed to the active protocol during weeks 4 to 6

Clinician summary

At week 3, MAS was 2 (IQR 2 to 3) versus 3 (2 to 3), p < 0.001, and FMA-UE was 22.2 +/- 5.63 versus 19.2 +/- 5.53, p = 0.010. Baseline-adjusted analyses also favored early treatment; by week 6, between-group differences were no longer significant after the delayed group crossed to active stimulation.

How to interpret the findings

The trial was registered retrospectively after enrollment began. Therapists were unblinded, active Erb's-point stimulation could reveal assignment, blinding success was not tested, and the sham could not fully reproduce sensory and motor effects. Follow-up was limited to 6 weeks, both groups received intensive rehabilitation, and spontaneous recovery or residual placebo effects cannot be fully excluded.

Equipment and disclosures

YRD CCY-I stimulator with Y125 liquid-nitrogen-cooled circular coil, Yiruide Medical Equipment New Technology Co., Ltd.; the source does not attribute other site content or outcomes to this equipment.

Funded by the Anhui Province Four New Research and Reform Practice Project and Anhui Medical University. The authors declared no commercial or financial relationships that could be construed as a potential conflict. Thirteen of 100 participants reported mild, transient adverse events; no serious adverse event was reported.

Related evidence

Compare findings from the same clinical area, including mixed results.

• Acupuncture combined with repetitive transcranial magnetic stimulation vs repetitive transcranial magnetic stimulation alone for recovery of hemiparesis after ischemic stroke: A systematic review and meta-analysis. · Positive with limitations
• Pain Outcomes and Exercise Data from the EXERT-Stroke Pilot Clinical Trial on Post-Stroke Headaches. · Mixed
• Motor Improvements Following Non-Invasive Brain Stimulation with kTMP: A Case Study of Cerebellar Stroke. · Positive with limitations
• Neuromodulation effects of HF-rTMS and rPMS on stroke patients: an fNIRS study. · Positive with limitations
• Validation of Low-Frequency Oscillatory Activity as an Indicator of Post-Stroke Injury and Recovery. · Positive with limitations