Transcranial magnetic stimulation in multiple sclerosis: Targeting symptoms through neuroplasticity

Background: Multiple sclerosis (MS) is a chronic neurological disorder characterized by autoimmune-mediated inflammation and neurodegeneration. Despite major advances in disease-modifying therapies, many people with MS continue to face significant challenges. Objectives: This topical review summarizes clinical studies over the past two decades examining transcranial magnetic stimulation (TMS) as a therapeutic approach for MS symptoms, including fatigue, motor dysfunction, spasticity, and cognitive impairment. Results: Available evidence suggests potential symptomatic benefits, particularly for motor/spasticity-related outcomes, and indicates that neuroplasticity remains at least partially preserved in MS, providing a plausible substrate for neuromodulation-based interventions. Moreover, TMS appears generally well-tolerated; however, findings are heterogeneous, and the evidence base includes few adequately powered sham-controlled trials across symptom domains. Conclusion: Overall, current findings support further controlled trials to clarify efficacy, durability, and patient-level predictors, and to inform stepwise clinical translation of TMS-based interventions as a complementary strategy to leverage residual neuroplasticity and reduce symptom burden in individuals with MS.