In 40 seconds
MS spasticity affects up to 80% of patients across the disease course and is one of the strongest evidence areas for magnetic stimulation in MS. iTBS over M1 (Mori 2010 in RRMS, Korzhova 2019 in SPMS) and HF-rTMS reduce Modified Ashworth Scale scores. The 2023 meta-analysis reported SMD −0.67 favouring rTMS — a moderate effect. iTBS effects last longer than standard HF-rTMS in SPMS (Korzhova 2019). Consumer PEMF mats have no completed sham-controlled RCT for MS spasticity. Standard NICE NG220 pathway — physiotherapy, baclofen, gabapentin, tizanidine, botulinum toxin for focal spasticity, intrathecal baclofen in refractory cases — remains first-line. Clinical rTMS is research-grade access only in the UK.
Quick facts
- MS spasticity prevalence: Up to 80% across disease course
- Best-supported protocol: iTBS over M1, 2 weeks daily
- Largest meta-analysis (2023): SMD −0.67 favouring rTMS on MAS
- SPMS-specific RCT: Korzhova 2019 (n=34) — both HF-rTMS and iTBS reduced MAS
- iTBS advantage: Longer-lasting MAS reduction in SPMS (Korzhova 2019)
- Consumer PEMF mat: No completed sham-controlled MS spasticity RCT
- First-line NICE NG220: Physio, baclofen, gabapentin, tizanidine, botulinum toxin
What the spasticity evidence shows
Spasticity is where MS-rTMS has the most reproducible signal. Centonze 2007 showed a single session of 5 Hz M1 rTMS reduced H/M reflex and clinical spasticity. Mori 2010 (n=20, daily iTBS over M1 for 2 weeks) reduced lower-limb spasticity and normalised H/M ratio. Mori 2011 showed iTBS "primes" exercise therapy — combined iTBS plus exercise produced the largest MAS and MSSS-88 reductions. Korzhova 2019 (n=34) is the only RCT in secondary progressive MS specifically: both HF-rTMS at 20 Hz and iTBS reduced MAS vs sham, with iTBS effects lasting longer (12 weeks). The 2023 meta-analysis pooled RCTs and found SMD −0.67 — a moderate effect by Cohen's convention.
Consumer low-intensity PEMF mats have no completed sham-controlled RCT for MS spasticity. The mechanism is fundamentally different — local cortical stimulation in rTMS vs whole-body subthreshold magnetic exposure in consumer PEMF.
Standard NICE NG220 pathway for MS spasticity remains first-line: physiotherapy with stretch programmes, oral baclofen, gabapentin, tizanidine, botulinum toxin for focal spasticity, sativex (where commissioned), and intrathecal baclofen in refractory cases. iTBS is research-trial-only in the UK — ask the MS consultant about trial availability if standard pathway is failing.
Frequently asked questions
Does rTMS work for MS spasticity?
Yes. Mori 2010, Korzhova 2019 and the 2023 meta-analysis (SMD −0.67) all show M1 stimulation reduces Modified Ashworth Scale scores.
Is iTBS better than standard rTMS?
For MS spasticity, Korzhova 2019 in SPMS showed iTBS effects last longer than HF-rTMS. iTBS is also faster (~3 min vs 30 min) and has lower seizure risk.
Can a PEMF mat replace baclofen?
No. Consumer PEMF mats have no completed RCT for MS spasticity. Baclofen and the standard NICE pathway remain first-line.
Is iTBS for MS spasticity available on the NHS?
No. NHS England commissions rTMS only for treatment-resistant depression. iTBS for MS spasticity is research-trial-only in the UK.
How long does an iTBS course take?
Trials typically run 10 daily sessions over 2 weeks. Maintenance protocols vary. Discuss with the trial team.
Are there UK trials of iTBS for MS spasticity?
Periodically — ClinicalTrials.gov is the registry. Major MS centres (Queen Square, Plymouth, Cambridge) recruit. Ask your MS consultant.
Can iTBS combined with physiotherapy be better than either alone?
Mori 2011 (n=30) showed iTBS plus exercise produced the largest MAS reduction. The 'priming' concept is supported.
What about sativex?
Sativex (THC/CBD) is NICE-commissioned for some MS spasticity in adults — separate from PEMF/rTMS. Standard pathway item.
Related pages
Looking for a PEMF clinic in the UK?
We list every credible PEMF therapy provider in the UK. No UK clinic can legally claim to treat MS with PEMF or rTMS.