{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T01:52:52Z","timestamp":1792029172771,"version":"4.4.0"},"reference-count":61,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T00:00:00Z","timestamp":1772582400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Spasticity is a common and disabling feature of several neuromotor disorders. Repetitive transcranial magnetic stimulation (rTMS) has been proposed as a non-invasive approach to modulate corticospinal excitability and reduce spasticity, although its clinical effectiveness remains debated. This systematic review evaluated the efficacy and safety of rTMS in reducing spasticity in stroke and other neuromotor conditions. Methods: A systematic search of PubMed, Scopus, and Cochrane Library was conducted up to June 2025 in accordance with PRISMA 2020 guidelines. Eligible studies were randomized controlled trials (RCTs) comparing rTMS with sham stimulation or conventional therapy and assessing spasticity using validated scales, primarily the Modified Ashworth Scale. Included populations comprised patients with stroke, spinal cord injury, multiple sclerosis, cerebral palsy, and hereditary spastic paraplegia. Risk of bias was assessed using the RoB 2.0 tool, and certainty of evidence was evaluated with GRADE. Results: Twenty-six RCTs were included, mainly involving stroke patients. Most studies reported a significant reduction in spasticity with rTMS compared with control interventions. Low-frequency stimulation was commonly used after stroke, while excitatory protocols predominated in other conditions. Benefits generally persisted for up to 12 weeks. Evidence quality was moderate, and no serious adverse events were reported. Conclusions: rTMS appears to be a safe and promising adjunctive treatment for spasticity across neuromotor disorders. However, protocol heterogeneity and small sample sizes limit definitive clinical recommendations, highlighting the need for standardized, larger-scale studies.<\/jats:p>","DOI":"10.3390\/jcm15051932","type":"journal-article","created":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T08:51:33Z","timestamp":1772614293000},"page":"1932","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Repetitive Transcranial Magnetic Stimulation for Spasticity in Stroke and Other Neuromotor Disorders: A Systematic Review of Randomized Clinical Trials"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-5756-790X","authenticated-orcid":false,"given":"Michele","family":"Iacona","sequence":"first","affiliation":[{"name":"Department of Medical and Surgical Sciences and Advanced Technologies \u201cG.F. Ingrassia\u201d, University of Catania, 95123 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6131-8552","authenticated-orcid":false,"given":"Rosario","family":"Ferlito","sequence":"additional","affiliation":[{"name":"Department of Biomedical and Biotechnological Sciences, University of Catania, 95123 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8332-6863","authenticated-orcid":false,"given":"Rita","family":"Bella","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences and Advanced Technologies \u201cG.F. Ingrassia\u201d, University of Catania, 95123 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9072-4971","authenticated-orcid":false,"given":"Mariagiovanna","family":"Cantone","sequence":"additional","affiliation":[{"name":"Neurology Unit, Policlinico University Hospital \u201cG. Rodolico-San Marco\u201d, 95123 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6937-3065","authenticated-orcid":false,"given":"Raffaele","family":"Ferri","sequence":"additional","affiliation":[{"name":"Oasi Research Institute-IRCCS, 94018 Troina, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1579-8807","authenticated-orcid":false,"given":"Francesco","family":"Fisicaro","sequence":"additional","affiliation":[{"name":"Primary Health Care Unit, Provincial Health Authority of Siracusa, 96100 Siracusa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8095-8678","authenticated-orcid":false,"given":"Salvatore","family":"Giunta","sequence":"additional","affiliation":[{"name":"Department of Biomedical and Biotechnological Sciences, University of Catania, 95123 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6104-6040","authenticated-orcid":false,"given":"Pietro","family":"Marano","sequence":"additional","affiliation":[{"name":"Oasi Research Institute-IRCCS, 94018 Troina, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6662-2281","authenticated-orcid":false,"given":"Maria P.","family":"Mogavero","sequence":"additional","affiliation":[{"name":"Oasi Research Institute-IRCCS, 94018 Troina, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5664-8066","authenticated-orcid":false,"given":"Vito","family":"Pavone","sequence":"additional","affiliation":[{"name":"Department of Surgery and Medical-Surgical Specialties, University of Catania, 95123 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manuela","family":"Pennisi","sequence":"additional","affiliation":[{"name":"Department of Biomedical and Biotechnological Sciences, University of Catania, 95123 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5246-9714","authenticated-orcid":false,"given":"Gianluca","family":"Testa","sequence":"additional","affiliation":[{"name":"Department of Surgery and Medical-Surgical Specialties, University of Catania, 95123 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-6459-2700","authenticated-orcid":false,"given":"Davide N.","family":"Tringali","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences and Advanced Technologies \u201cG.F. Ingrassia\u201d, University of Catania, 95123 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5659-662X","authenticated-orcid":false,"given":"Giuseppe","family":"Lanza","sequence":"additional","affiliation":[{"name":"Oasi Research Institute-IRCCS, 94018 Troina, Italy"},{"name":"Department of Surgery and Medical-Surgical Specialties, University of Catania, 95123 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,4]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"122925","DOI":"10.1016\/j.jns.2024.122925","article-title":"Current opinions and practices in post-stroke movement disorders: Survey of movement disorders society members","volume":"458","author":"Sarva","year":"2024","journal-title":"J. Neurol. 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