Spasticity Management: The Current State of Transcranial Neuromodulation

Antonino Leo, Antonino Naro, Francesco Molonia, Provvidenza Tomasello, Ileana Saccá, Alessia Bramanti, Margherita Russo, Placido Bramanti, Angelo Quartarone, Rocco Salvatore Calabrò

Research output: Contribution to journalReview articlepeer-review


This narrative review aims to provide an objective view of the noninvasive neuromodulation (NINM) protocols available for treating spasticity, including repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS). On the basis of the relevant randomized controlled trials, we infer that NINM is more effective in reducing spasticity when combined with the conventional therapies than used as a stand-alone treatment. However, the magnitude of NINM after-effects depends significantly on the applied hemisphere and the underlying pathology. Being in line with these arguments, low-frequency rTMS and cathodal-tDCS over the unaffected hemisphere are more effective in reducing spasticity than high-frequency rTMS and anodal-tDCS over the affected hemisphere in chronic poststroke. However, most of the studies are heterogeneous in the stimulation setup, patient selection, follow-up duration, and the availability of the sham operation. Therefore, the available data on the usefulness of NINM in reducing spasticity need to be confirmed by larger and multicentric randomized controlled trials to gather evidence on the efficiency of NINM regimens in reducing spasticity in various neurologic conditions.


Original languageEnglish
Pages (from-to)1020-1029
Number of pages10
JournalPM and R
Issue number10
Publication statusPublished - Oct 2017


  • Journal Article
  • Review


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