The role of the dorsolateral prefrontal cortex in the inhibition of stereotyped responses.

Stereotyped behaviors should be inhibited under some circumstances in order to encourage appropriate behavior. Psychiatrists have used the modified rock-paper-scissors (RPS) task to examine the inhibition of stereotyped behavior. When subjects are required to lose in response to a gesture, it is difficult for them to lose, and they have a tendency to win involuntarily. It is thought that the win response is the stereotyped response in the RPS task, and the difficulty in making positive attempts to lose is due to the requirement for inhibition of the stereotyped response. In this study, we investigated the brain regions related to inhibition of the stereotyped response using functional magnetic resonance imaging (fMRI). Subjects were assigned to one of two groups: the "win group" or the "lose group." The lose group showed higher activation of the left dorsolateral prefrontal cortex (DLFPC) when compared to the win group. We also delivered transcranial magnetic stimulation (TMS) while the subjects performed the modified RPS task to investigate whether the left DLPFC (middle frontal gyrus, Brodmann area, BA 9) was directly involved in the inhibition of the stereotyped response. When TMS was delivered before onset of the visual stimulus, the subjects displayed increased response errors. In particular, the subjects had a tendency to win erroneously in a lose condition even though they were required to lose. These results indicate involvement of the left DLPFC in inhibition of the stereotyped responses, which suggests that this region is associated with inhibition of the preparatory setting for stereotyped responses rather than inhibition of ongoing processing to produce a stereotyped response.