---
title: "DLPFC continuous theta burst stimulation improves force steadiness without visual feedback"
id: "pubmed-42474339"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42474339"
content_type: "clinical_feed_article"
specialty: "Neurology"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42474339/"
doi: "10.1097/WNR.0000000000002290"
published_at: "2026-09-02T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# DLPFC continuous theta burst stimulation improves force steadiness without visual feedback
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42474339
- **Specialty:** [Neurology](https://medichelpline.com/clinical-feed/neurology.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42474339/)
- **DOI:** [10.1097/WNR.0000000000002290](https://doi.org/10.1097%2FWNR.0000000000002290)
- **Published At:** 2026-09-02T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- Study tested whether modulating the **dorsolateral prefrontal cortex (DLPFC)** with theta-burst transcranial stimulation affects force steadiness during submaximal isometric contraction when visual feedback is removed. - Twenty-eight healthy adults were randomized to receive either inhibitory continuous TBS (cTBS) or facilitatory intermittent TBS over the left DLPFC. - Task: 35% submaximal isometric wrist flexion performed without visual feedback; primary outcome was the coefficient of variation of submaximal force (force steadiness). - Secondary measures included motor evoked potentials (MEPs) as an index of corticospinal excitability and maximal voluntary contraction (MVC) force. - After cTBS, the coefficient of variation of submaximal force significantly decreased at 15 minutes poststimulation (P = 0.013), indicating improved **force steadiness**. - The steadiness improvement occurred without significant changes in **MEP amplitudes**, **maximal voluntary contraction**, or the mean level of submaximal force. - Authors conclude transient inhibition of the left **DLPFC** can enhance motor output stability under limited-feedback conditions, likely via improved sensorimotor integration or reduced maladaptive internal monitoring. - The observed effect was not accompanied by detectable changes in resting **corticospinal excitability**, suggesting the mechanism is not reflected in baseline MEP amplitude changes. - Study keywords: dorsolateral prefrontal cortex; force steadiness; theta burst transcranial stimulation.
## Clinical Analysis & Structured Key Points
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Epub 2026 Jul 7. # Continuous theta burst stimulation over the dorsolateral prefrontal cortex improves force steadiness during submaximal contractions without visual feedback [Taishi Okegawa](https://pubmed.ncbi.nlm.nih.gov/?term=Okegawa+T&cauthor_id=42474339)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42474339/#full-view-affiliation-1 "Department of Life Sciences, Graduate School of Arts and Sciences, The University of Tokyo."), [Naotsugu Kaneko](https://pubmed.ncbi.nlm.nih.gov/?term=Kaneko+N&cauthor_id=42474339)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42474339/#full-view-affiliation-1 "Department of Life Sciences, Graduate School of Arts and Sciences, The University of Tokyo."), [Daiki Yamasaki](https://pubmed.ncbi.nlm.nih.gov/?term=Yamasaki+D&cauthor_id=42474339)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42474339/#full-view-affiliation-1 "Department of Life Sciences, Graduate School of Arts and Sciences, The University of Tokyo.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42474339/#full-view-affiliation-2 "Japan Society for the Promotion of Science, Tokyo, Japan."), [Kimitaka Nakazawa](https://pubmed.ncbi.nlm.nih.gov/?term=Nakazawa+K&cauthor_id=42474339)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42474339/#full-view-affiliation-1 "Department of Life Sciences, Graduate School of Arts and Sciences, The University of Tokyo.") Affiliations Expand ### Affiliations * 1 Department of Life Sciences, Graduate School of Arts and Sciences, The University of Tokyo. * 2 Japan Society for the Promotion of Science, Tokyo, Japan. * PMID: **42474339** * DOI: [ 10.1097/WNR.0000000000002290 ](https://doi.org/10.1097/wnr.0000000000002290) Item in Clipboard Randomized Controlled Trial # Continuous theta burst stimulation over the dorsolateral prefrontal cortex improves force steadiness during submaximal contractions without visual feedback Taishi Okegawa et al. Neuroreport. 2026. Show details Display options Display options Format Abstract PubMed PMID Neuroreport Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Neuroreport%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Neuroreport%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42474339/) . 2026 Sep 2;37(13):515-523. doi: 10.1097/WNR.0000000000002290. Epub 2026 Jul 7. ### Authors [Taishi Okegawa](https://pubmed.ncbi.nlm.nih.gov/?term=Okegawa+T&cauthor_id=42474339)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42474339/#short-view-affiliation-1 "Department of Life Sciences, Graduate School of Arts and Sciences, The University of Tokyo."), [Naotsugu Kaneko](https://pubmed.ncbi.nlm.nih.gov/?term=Kaneko+N&cauthor_id=42474339)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42474339/#short-view-affiliation-1 "Department of Life Sciences, Graduate School of Arts and Sciences, The University of Tokyo."), [Daiki Yamasaki](https://pubmed.ncbi.nlm.nih.gov/?term=Yamasaki+D&cauthor_id=42474339)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42474339/#short-view-affiliation-1 "Department of Life Sciences, Graduate School of Arts and Sciences, The University of Tokyo.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42474339/#short-view-affiliation-2 "Japan Society for the Promotion of Science, Tokyo, Japan."), [Kimitaka Nakazawa](https://pubmed.ncbi.nlm.nih.gov/?term=Nakazawa+K&cauthor_id=42474339)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42474339/#short-view-affiliation-1 "Department of Life Sciences, Graduate School of Arts and Sciences, The University of Tokyo.") ### Affiliations * 1 Department of Life Sciences, Graduate School of Arts and Sciences, The University of Tokyo. * 2 Japan Society for the Promotion of Science, Tokyo, Japan. * PMID: **42474339** * DOI: [ 10.1097/WNR.0000000000002290 ](https://doi.org/10.1097/wnr.0000000000002290) Item in Clipboard Full text links Cite Display options Display options Format Abstract PubMed PMID ## Abstract **Background:** Without visual feedback, the central nervous system must rely on the integration of internal models and proprioceptive information. While the dorsolateral prefrontal cortex (DLPFC) is involved in motor control and sensorimotor monitoring, whether it causally influences force steadiness and whether any such influence is dependent on corticospinal excitability remains unclear. **Objective:** This study aimed to investigate whether modulating DLPFC activity using theta burst transcranial stimulation (TBS) influences force steadiness during submaximal contractions performed without visual feedback, and whether this depends on corticospinal excitability. **Methods:** Twenty-eight healthy volunteers were randomly assigned to receive either inhibitory continuous TBS (cTBS) or facilitatory intermittent TBS over the left DLPFC. Participants performed a 35% submaximal isometric wrist flexion task without visual feedback. We assessed the submaximal force and its coefficient of variation. Motor evoked potentials (MEPs) and maximal voluntary contraction force were also measured at pre, 15 min, and 30 min poststimulation. **Results:** Following cTBS, the coefficient of variation of submaximal force significantly decreased at 15 min poststimulation ( P = 0.013), indicating improved force steadiness. This improvement occurred without any significant changes in MEP amplitudes, maximal voluntary contraction force, or the mean level of submaximal force production. **Conclusion:** Transient inhibition of the left DLPFC may enhance force steadiness without visual feedback. This enhancement was not accompanied by detectable changes in resting corticospinal excitability. These results suggest that the DLPFC contributes to the qualitative stability of motor output, possibly by optimizing sensorimotor integration and mitigating maladaptive monitoring of internal feedback under limited-feedback situations. **Keywords:** dorsolateral prefrontal cortex; force steadiness; theta burst transcranial stimulation. Copyright © 2026 Wolters Kluwer Health, LLC. All rights reserved. [PubMed Disclaimer](https://pubmed.ncbi.nlm.nih.gov/disclaimer/) ## Similar articles * [ The effects of forearm position and contraction intensity on cortical and spinal excitability during a submaximal force steadiness task of the elbow flexors. ](https://pubmed.ncbi.nlm.nih.gov/31774348/) Yacyshyn AF, Kuzyk S, Jakobi JM, McNeil CJ.Yacyshyn AF, et al.J Neurophysiol. 2020 Feb 1;123(2):522-528. doi: 10.1152/jn.00349.2019. Epub 2019 Nov 27.J Neurophysiol. 2020.PMID: 31774348Free PMC article. * [ Motor imagery improves force control in older and young females. ](https://pubmed.ncbi.nlm.nih.gov/40684972/) Calkins CA, Kraeutner SN, McNeil CJ, Jakobi JM.Calkins CA, et al.Brain Res. 2025 Oct 15;1865:149845. doi: 10.1016/j.brainres.2025.149845. Epub 2025 Jul 18.Brain Res. 2025.PMID: 40684972Clinical Trial. * [ Theta-Burst Stimulation Modulates Exercise Performance by Influencing Central Fatigue and Corticospinal Excitability. ](https://pubmed.ncbi.nlm.nih.gov/39576139/) Martignon C, Barbi C, Vernillo G, Sidhu SK, Andani ME, Schena F, Venturelli M.Martignon C, et al.Med Sci Sports Exerc. 2025 Apr 1;57(4):716-726. doi: 10.1249/MSS.0000000000003611. Epub 2024 Nov 22.Med Sci Sports Exerc. 2025.PMID: 39576139 * [ Intersegmental Modulation of Lower-Limb Corticospinal Excitability and Inhibition Induced by Upper-Limb Isometric Contractions: A Systematic Review. ](https://pubmed.ncbi.nlm.nih.gov/41968539/) de Mello Rosa GH, Pereira GS, da Silva Boni F, da Silva ML, de Araújo JE.de Mello Rosa GH, et al.Eur J Neurosci. 2026 Apr;63(7):e70501. doi: 10.1111/ejn.70501.Eur J Neurosci. 2026.PMID: 41968539Free PMC article. * [ Use of theta-burst stimulation in changing excitability of motor cortex: A systematic review and meta-analysis. ](https://pubmed.ncbi.nlm.nih.gov/26850210/) Chung SW, Hill AT, Rogasch NC, Hoy KE, Fitzgerald PB.Chung SW, et al.Neurosci Biobehav Rev. 2016 Apr;63:43-64. doi: 10.1016/j.neubiorev.2016.01.008. Epub 2016 Feb 3.Neurosci Biobehav Rev. 2016.PMID: 26850210 [ See all similar articles ](https://pubmed.ncbi.nlm.nih.gov/?linkname=pubmed_pubmed&from_uid=42474339) ## References 1. 1. Enoka RM, Farina D. Force steadiness: from motor units to voluntary actions. Physiology (Bethesda) 2021; 36:114–130. 2. 1. Saunders JA, Knill DC. Visual feedback control of hand movements. J Neurosci 2004; 24:3223–3234. 3. 1. Riemann BL, Lephart SM. The sensorimotor system, part I: the physiologic basis of functional joint stability. J Athl Train 2002; 37:71–79. 4. 1. Proske U, Gandevia SC. The proprioceptive senses: their roles in signaling body shape, body position and movement, and muscle force. Physiol Rev 2012; 92:1651–1697. 5. 1. Vaillancourt DE, Slifkin AB, Newell KM. Visual control of isometric force in Parkinson’s disease. Neuropsychologia 2001; 39:1410–1418. 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