The effects of theta burst stimulation (TBS) targeting the prefrontal cortex on executive functioning: A systematic review and meta-analysis
Abstract
Theta burst stimulation (TBS) is a highly efficient repetitive transcranial magnetic stimulation (rTMS) variant employed in experimental and clinical treatment paradigms. Despite widespread usage of TBS targeting the prefrontal cortex (PFC), there has been no systematic review of the evidence linking TBS protocols to changes in task performance on common measures of prefrontal function in general, and executive functions specifically. A systematic review of the literature was conducted using PsycINFO, PubMed, Web of Science and Scopus databases to identify articles examining the effects of TBS targeting the PFC on executive function task performance. Both the up-regulating (intermittent theta burst stimulation; iTBS) and down-regulating (continuous theta burst stimulation; cTBS) variants of TBS were considered. 32 (29 cTBS; 8 iTBS) studies met the inclusion criteria. Participants (n = 759; 51.41% female) were primarily young adults (M age = 26), with one study examining the effects of cTBS and iTBS in older adults. Results from individual studies were converted to Hedge's g and random-effects models were used to estimate the overall effect size for each protocol. Age, biological sex, and control methodology were examined as potential moderators of the cTBS effect on executive function test performance. Findings indicated a- reliable attentuating effect of cTBS on executive function task performance (g = -.244, Z = -5.920, p < .001); this effect was relatively uniform across included studies (Q= 24.178, p = .838, I 2 = 0). Although no significant moderators of the cTBS effect were identified, laterality sub analyses indicated that the magnitude of the effect was significantly higher (M diff = .213, Z diff = 2.546, p = .011) for left-sided (g = -.358, Z = -5.816, p < .001) relative to right-sided (g = -.145, Z = -2.552, p = .011) PFC stimulation. A systematic review of iTBS studies revealed variability in reliability of effects though most were in the theorized direction. TBS protocols appear to be effective in modulating prefrontal cortical excitability in previously theorized directions.
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Investigations employing iTBS in healthy individuals across age groups suggested that the modulation of executive function varied depending on the task, with older participants exhibiting more pronounced effects.
“Furthermore, investigations employing iTBS in a sample of healthy individuals spanning various age groups suggested that the modulation of executive function varied depending on the task, with older participants exhibiting more pronounced effects.15”
From Can Intermittent Theta-Burst Stimulation of Dorsolateral Prefrontal Cortex Relieve Executive Dysfunction in Patients With Late-Life Depression? (2024) · cites this paper as [15]
A previous meta-analysis demonstrated that cTBS targeting the PFC of healthy groups resulted in a decline in executive function performance.
“A previous meta-analysis demonstrated that cTBS targeting the PFC of healthy groups resulted in a decline in executive function performance.15”
From Can Intermittent Theta-Burst Stimulation of Dorsolateral Prefrontal Cortex Relieve Executive Dysfunction in Patients With Late-Life Depression? (2024) · cites this paper as [15]
The authors postulated that iTBS may have a promoting effect on executive processes, especially working memory.
“In addition, the authors postulated that iTBS may have a promoting effect on executive processes, especially working memory.15”
From Can Intermittent Theta-Burst Stimulation of Dorsolateral Prefrontal Cortex Relieve Executive Dysfunction in Patients With Late-Life Depression? (2024) · cites this paper as [15]
Studies have demonstrated enhancement of neurocognitive performance among healthy individuals and clinical populations including MCI, Parkinson disease, stroke, polysubstance use disorder, and schizophrenia.
“Studies have demonstrated enhancement of neurocognitive performance among healthy individuals (Lowe et al., 2018) and clinical populations including MCI (Chen et al., 2022), Parkinson disease (He et al., 2021), stroke (Tsai et al., 2020), polysubstance use disorder (Dong et al., 2023), and schizophrenia (Zhang et al., 2023).”
From Neurocognitive effects of theta burst stimulation for treatment-resistant depression in adults: A systematic review and recommendations for future research (2025) · cites this paper as Lowe et al., 2018
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iTBS to Relieve Depression and Executive Dysfunction in Older Adults: An Open Label Study
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- Authors
- Lowe, C. J., Manocchio, F., Safati, A. B., & Hall, P. A.
- Affiliations
- University of Waterloo (CA)
- Corresponding author
- Hall, Peter A.
- Venue
- Neuropsychologia
- Publisher
- Elsevier BV
- Published
- 2018-03
- Volume
- 111
- Pages
- 344-359
- ISSN
- 0028-3932 (ISSN-L)
- OpenAlex
- W2792679700
- Cited by
- 115
- References
- 21
- Citations by year
- 2026: 5 · 2025: 16 · 2024: 14 · 2023: 14 · 2022: 8 · 2021: 21 · 2020: 16 · 2019: 13 · 2018: 8
- FWCI
- 1.37
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Neuropsychologia (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Life Sciences › Neuroscience › Neurology › Transcranial Magnetic Stimulation Studies
- Life Sciences › Neuroscience › Cognitive Neuroscience › Neural and Behavioral Psychology Studies
- Social Sciences › Psychology › Clinical Psychology › Obsessive-Compulsive Spectrum Disorders
- Keywords
- theta burst stimulation, prefrontal cortex, executive function, continuous theta burst stimulation, intermittent theta burst stimulation, repetitive transcranial magnetic stimulation, hemispheric lateralization, task performance
- MeSH terms
- Humans, Prefrontal Cortex, Transcranial Magnetic Stimulation, Executive Function
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