Effects of 10-Hz rTMS over the leg motor cortex using a double-cone coil on lower limb motor recovery in subacute stroke: a randomised, double-blind, sham-controlled study.

Only patients within six months of stroke who were already at Brunnstrom stages III-IV were included, so this says nothing about very early, very severe or chronic stroke. There was no follow-up after three weeks, so it is unknown whether the small extra leg-motor and balance gain lasts or fades once the stimulation stops. The 1.5-point leg-motor difference at three weeks is small on a 34-point scale, and the groups were not separated at weeks one or two, so the clinical size of the benefit is modest. The sham coil only mimicked the sound, not the scalp sensation, and the authors acknowledge a risk that the experienced TMS operator could work out who was who. The leg-motor gain appeared only at three weeks, so a shorter course may not produce the same effect. Fifty-one of the fifty-six randomised patients were analysed, and the missing data were filled in by carrying forward the last available score.

Funding came from the Wuxi Health Committee Youth Project, the National Natural Science Foundation of China, the Shanghai Sailing Program and the Wuxi Health Committee Top Talent Support Program. No commercial sponsor that sells the rTMS device is listed, and no author conflicts are declared in the text.

Do not read this as proof that rTMS on its own restores leg function. Both groups improved significantly on the leg-motor and balance scores because they were all doing an hour of conventional rehabilitation every day, and the stimulation added only 1.5 points on the 34-point leg-motor scale at three weeks. The stimulation is an add-on to therapy, not a replacement for it.