The pre-supplementary motor area achieves inhibitory control by modulating response thresholds

The pre-supplementary motor area (pre-SMA) is central for the initiation and inhibition of voluntary action. For the execution of action, the pre-SMA optimises the decision of which action to choose by adjusting the thresholds for the required evidence for each choice. However, it remains unclear how the pre-SMA contributes to action inhibition. Here, we use computational modelling of a stop/no-go task, performed by an adult with a focal lesion in the pre-SMA, and 52 age-matched controls. We show that the patient required more time to successfully inhibit an action (longer stop-signal reaction time) but was faster in terms of go reaction times. Computational modelling revealed that the patient's failure to stop was explained by a significantly lower response threshold for initiating an action, as compared to controls, suggesting that the patient needed less evidence before committing to an action. A similarly specific impairment was also observed for the decision of which action to choose. Together, our results suggest that dynamic threshold modulation may be a general mechanism by which the pre-SMA exerts its control over voluntary action.