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In this issue of Neurology, Khedr et al.1 report results of a randomized trial evaluating the impact of repetitive transcranial magnetic stimulation (rTMS) on motor recovery after stroke. TMS stimulates underlying brain with electromagnetic pulses and has been used to study cortical organization by tracking motor responses to focal stimulation. It also may have therapeutic effects. TMS can affect synaptic long-term potentiation and depression by modulating neurotransmitter availability and postsynaptic receptor density both in cortical neurons directly underlying the stimulus and among those connected to them. In theory, this could mediate neuroprotection locally and effect diaschisis at a distance.2,3 In fact, clinical studies of TMS have shown improvements in motor function in patients …
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