Repetitive transcranial magnetic stimulation for the treatment of restless legs syndrome

Background: The benefit of repetitive transcranial magnetic stimulation (rTMS) in patients with Restless Legs Syndrome (RLS) is uncertain. This study was performed to explore the therapeutic effect of rTMS in treating RLS. Methods: Databases including PubMed, EMbase, the Cochrane Library, China National Knowledge Infrastructure, and Wanfang database were searched from their inception to May 1, 2026. Eligible studies comparing rTMS with sham stimulation were included. Data were analyzed using Review Manager Version 5.3. Results: Four studies were included in the meta-analysis. The overall pooled analysis confirmed that rTMS could effectively reduce International RLS-Rating Scale (IRLS-RS) scores (mean difference [MD] = 6.46, 95% confidence interval [CI]: 4.44 –8.48, P < .00001) and Pittsburgh sleep quality index (PSQI) scores (MD = 4.80, 95% CI: 3.51–6.08, P < .00001) at different follow-up periods. Meanwhile, the overall pooled analysis confirmed that rTMS could effectively reduce IRLS-RS scores (MD = 7.79, 95% CI: 3.90–11.68, P < .0001) and PSQI scores (MD = 5.58, 95% CI: 3.81–7.35, P < .00001) in the subgroup analysis by RLS subtype. However, rTMS showed no significant effect on PSQI scores in primary RLS (MD = 1.86, 95% CI: −2.65–6.37, P = .42). In addition, the overall pooled analysis confirmed that both low-frequency and high-frequency rTMS could effectively reduce IRLS-RS scores (MD = 7.79, 95% CI: 3.90–11.68, P < .0001) and PSQI scores (MD = 5.58, 95% CI: 3.81–7.35, P < .00001). Finally, the overall pooled analysis confirmed that rTMS could not significantly reduce Hamilton anxiety scale and Hamilton depression scale scores in subgroup analyses of follow-up period, RLS subtype, or rTMS frequency ( P > .05). Conclusion: rTMS might alleviate core limb discomfort symptoms measured by IRLS-RS and improve sleep quality assessed by PSQI in patients with RLS. However, rTMS might not be effective in improving symptoms of anxiety and depression. To further confirm the conclusion, more large randomized controlled trials are necessary.