الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Optimizing the management of stroke is a national priority Stroke is a highly disability disease affecting millions of people worldwide with estimate of 25 million stroke survivor in 2013 .In Egypt, the mean crude prevalence rate of stroke is 721.6/100,000 which adds significant burden to costs of the health care
Post stroke spasticity is a relatively common complication after stroke. It impairs the motor recovery and adds burden to patient, caregiver and society.
PMS is a relatively new modality of management of motor complications .Applying peripheral iTBS to spastic muscles has been investigated in limited studies.
Our RCT is the first study in Egypt to investigate iTBS in peripheral stimulation. In our RCT, we investigated the effects of 6 sessions of iTBS over the spastic muscles of upper and lower limb in forty six chronic stroke patients with spasticity. Our results showed significant improvement in tone, power and functional outcome in the active group compared to sham.
This effect was long lasting and could be detected after 1 month of follow up of the active group suggesting a LTP-like effect.
It is proposed that PMS is effective through stimulation of muscle contractions thus sending massive proprioceptive input to the brain which improve neural excitability and neuroplasticity .
This may explain why the improvement of functions and power outweigh the improvement of tone .
The exact underlying mechanisms of improvements are still unclear and therefore further studies are recommended.
Also further studies to compare the effects of iTBS to the effects of botulinum toxin injections and central TMS in management of spasticity are needed.