Inclusion Criteria- first onset, mono-hemispheric ischemic stroke in the middle cerebral artery territory;
- onset of symptoms within 48 hours;
- National Institutes of Health Stroke Scale (NIHSS) score between 4 and 25;
- signed written informed consent.
Exclusion Criteria- acute intracranial hemorrhage;
- previous ischemic or hemorrhagic stroke;
- lacunar stroke, defined as not involving the cortex and < 2.0 cm if measured on MRI diffusion-weighted images;
- contraindications to transcranial magnetic stimulation such as implanted metallic parts of implanted electronic devices or other metal in body;
- historical modified Rankin Scale (mRS) >1;
- other serious or complex disease that may confound treatment assessment;
- women known to be pregnant, lactating or having a positive or indeterminate pregnancy test;
- current participation in another study.