Background: The role of repetitive transcranial magnetic stimulation (rTMS) in improving post-stroke recovery has been suggested due to its known modulatory effect on the cortical excitability. It might be therapeutically used either by high-frequency stimulation (>1 Hz) to the motor cortex of the affected cerebral hemisphere, or by low-frequency stimulation (≤1 Hz) to the motor cortex of the nonlesional hemisphere. Objective: This study was aimed to evaluate the clinical and neurophysiological improvement after ipsilesional high-frequency rTMS in patients with acute ischemic stroke. Patients and methods: Fifty patients of both sexes were included in this randomized double-blind sham-controlled study in the period between July, 2021 and March, 2022. Patients included were admitted to the Stroke Unit, Department of Neurology, Minia University Hospital. TMS sessions were delivered for 7 consecutive days. All patients were both clinically and neurophysiologically evaluated just before the beginning of the 1^st rTMS session and after the end of the 7^th session. Patients were clinically evaluated by Medical Research Council (MRC) scale, National Institutes of Health Stroke Scale (NIHSS) and Modified Rankin scale (mRS). Neurophysiologically, patients were evaluated by measuring the resting motor threshold (RMT) to ipsilesional and contralesional abductor pollicis brevis (APB) muscles and the central motor conduction time (CMCT) in lesion side. Results: Twenty-five patients were subjected to real rTMS and twenty-five to sham stimulation. After the end of sessions, there was significant clinical and neurophysiological improvement in outcome in the favor of real rTMS group. Conclusion: It could be concluded thatipsilesional high-frequency rTMS improves recovery in patients with acute ischemic stroke.