Zanette 2008.

Methods	Prospective RCT 2 weeks treatment and 2 weeks follow‐up
Participants	10 patients with probable or definite ALS were enrolled. 5 participants in active stimulation group and 5 participants in sham stimulation group Age: 43 to 72 years Men: 7 Women: 3 Disease duration: 7 to 18 months
Interventions	Experimental group: for upper‐limb cortical areas on both sides, a Super Rapid magnetic stimulator (The Magstim Co., UK) connected to a figure‐of‐eight focal coil was performed (5Hz, 20 trains of 15 stimuli, 60 s interval between trains; 110% resting motor threshold). rTMS was delivered for 5 consecutive days per week for 2 weeks Control group: performed using the same stimulator connected to a specific sham coil that have no stimulating effect on the cortex but produces similar auditory and scalp sensations as the active coil treatment with manipulation, which delivered 5 consecutive days per week for 2 weeks All participants were taking riluzole
Outcomes	Changes in ALSFRS‐R scores, muscle strength and fatigue 2 weeks after the end of rTMS
Notes	It was a single centre trial carried out in Italy
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	"a randomised trial on a group of ALS patients", the detailed method was not stated
Allocation concealment (selection bias)	Unclear risk	"a randomised trial on a group of ALS patients", the detailed method was not stated
Blinding of participants and personnel (performance bias) All outcomes	Low risk	Identical stimulator used for the real rTMS and placebo rTMS, to ensure participants and the neurologists administering the intervention were unaware of the study group
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	The study report does not state whether investigators were blinded to treatment assignment until completion of the final analyses.
Incomplete outcome data (attrition bias) All outcomes	Low risk	Four weeks assessments were available for all randomised participants
Selective reporting (reporting bias)	Low risk	All pre‐specified outcomes were reported in the results section of the manuscript
Other bias	Low risk	There were no other concerns regarding the risk of bias in this study

ALS: amyotrophic lateral sclerosis; ALSFRS‐R: Amyotrophic Lateral Sclerosis Functional Rating Scale‐Revised; BDNF: brain derived neurotrophic factor; RCT: randomised controlled trial; rTMS: repetitive transcranial magnetic stimulation.