Background: A variety of effective modalities are available for the treatment of spasticity among which Botulinum toxin (BTX-A) emerged as the solution for most of stroke survivors. Repetitive Transcranial Magnetic Stimulation (rTMS) is thought to be beneficial in motor recovery after stroke through modulation of cortical excitability and augmentation of the response to afferent input. Aim of work: To detect whether the combination of BTX-A injection and application of (rTMS) on treating upper limb spasticity in stroke hemiplegic patients will be superior than using botulinum toxin alone or not. Patients and methods: Twenty patients (10 males, 10 females) who aged between 29 and 72 years suffering from hemiplegia due to cerebro-vascular stroke. They were divided randomly into two groups A andB (10 patients each). Group (A) recieved BTX-A injection only while Group (B) received BTX-A followed by rTMS at 1Hz applied to contralateral (non-lesional) cerebral hemisphere. All cases were assessed at baseline then follow up was performed at 2, 6 and 12 weeks post injection. Assessments included Range of motion (ROM), the Modified Ashworth Scale (MAS) and Tardieu scale (TS) for both the elbow and wrist joints. Results: Clinical improvement was noticed in both groups at 2 weeks after BTX-A injections, as shown by increase in the ROM post injection at both the elbow (range: 10-30⁰), and wrist joints (range: 0-15⁰). The clinical benefit was more evident at 6 weeks with better MAS. Improvement in Tardieu scale was also seen at week 6 at both the elbow and wrist joints and lasted till the end of the study (week 12). There was statistically significant improvement in scores in both groups at each point in comparison to baseline with no significant difference between the 2 groups. Conclusion: It has been shown that treatment with BTX-A alone or in combination with rTMS significantly decreases spasticity and increases range of motion in the upper extremity in stroke survivors. However, the addition of (rTMS) was not superior to using botulinum toxin alone.