Abstract Background and aims Functional recovery in chronic stroke (≥6 months) is limited by reduced neuroplasticity. We report a case applying a multi-site neuromodulation protocal combining bilateral M1 and midline Cz rTMS, each paired with peripheral magnetic stimulation (PMS), in a patient 8 months after hemorrhagic stroke onset. Methods A 45-year-old man with right hemiparesis (MRC 3/5), spasticity, and wheelchair dependence underwent 80 sessions over 4 months, alternating between: Followed by 60-minute task training; outcomes: MAS, FMA-UE/LE, FIM. Results Spasticity decreased and strength improved (MRC 3/5 → 4/5). Hand spasticity lessened with better finger extension. FMA-UE increased by 5, FMA-LE by 4, and FIM by 19. The patient regained stable independent walking with improved knee and ankle control, performed transfers and daily activities without assistance. Conclusions An alternating multi-site rTMS + PMS regimen produced meaningful motor and functional gains in chronic stroke. Synchronized activation of bilateral M1, Cz, and peripheral muscles may enhance afferent–efferent coupling and restore interhemispheric balance. The prolonged protocol was selected to induce cumulative plasticity and sustain cortical excitability, supporting network-based neuromodulation that may extend the neuroplastic window in late-phase stroke rehabilitation. Conflict of interest Name of author: nothing to disclose Figure 1 - belongs to Background and aims Figure 2 - belongs to Methods Figure 3 - belongs to Results Figure 4 - belongs to Conclusions
Pham et al. (Fri,) studied this question.