Effects of MRI-Navigated Intermittent Theta Burst Stimulation on Task Performance, Subjective Workload, and EEG Responses During Prolonged Simulated Flight: A Randomized Crossover Study.

Prolonged simulated flight is accompanied by progressive performance decay and escalating subjective workload. Whether intermittent theta burst stimulation (iTBS) over the left dorsolateral prefrontal cortex (DLPFC) can sustain performance and attenuate workload during sustained human-machine interaction remains unclear. To address this gap, we conducted a randomized, order-balanced, within-subject crossover study in which 25 healthy men completed a 60-min simulated flight (three 20-min phases) under MRI-navigated active iTBS (600 pulses, 80% of the resting motor threshold), sham iTBS, or no stimulation, with concurrent electroencephalography (EEG) recording. Objective performance was quantified using a composite performance score (CPS), and subjective workload was indexed by the NASA Task Load Index (NASA-TLX). Behaviorally, significant condition × phase interactions showed that active iTBS yielded higher CPS than both comparators in Phases 2-3 and lower NASA-TLX scores in Phase 3. At the neural level, task-state EEG revealed relative reductions in frontocentral theta and fronto-parieto-occipital alpha power under active iTBS in the later phases. Exploratory analyses further suggested that greater frontal alpha reductions tended to accompany larger CPS gains, although this association did not survive FDR correction. These findings suggest that MRI-navigated left-DLPFC iTBS was associated with better maintenance of task performance and lower subjective workload during the later stages of a prolonged simulated flight task. Given the small, homogeneous sample and the absence of real-flight scenarios, these results should be interpreted as preliminary laboratory evidence rather than evidence for operational efficacy or direct neuroergonomic application.