Background: Multiple sclerosis (MS) is associated with cognitive, affective, fatigue-related, and motor symptoms that may persist despite conventional management. Neurofeedback and biofeedback have been proposed as non-invasive interventions to support self-regulation and functional recovery, but their clinical value in MS remains unclear. Objective: To systematically review the effects of neurofeedback and biofeedback on cognitive, affective, and motor outcomes in adults with MS. Methods: PubMed, Scopus, Web of Science Core Collection, and PsycINFO were searched from inception to 7 April 2026 in accordance with a prospectively registered PROSPERO protocol (CRD420261339933). Interventional studies evaluating neurofeedback and/or biofeedback in adults with MS were eligible. Study selection was performed independently by three reviewers, whereas data extraction and risk-of-bias assessment were performed independently by two reviewers. Because of substantial heterogeneity in interventions, designs, and outcomes, findings were synthesized narratively. Results: Ten studies met the eligibility criteria. Neurofeedback studies reported improvements in depressive symptoms and selected cognitive outcomes in some samples, particularly in responder subgroups or combined treatment approaches, whereas biofeedback studies reported improvements in selected gait, balance, and postural outcomes. However, these findings were derived from a small and methodologically heterogeneous evidence base with substantial risk of bias and should therefore be interpreted cautiously. Findings for fatigue were mixed, and evidence for quality of life, sleep, and other secondary outcomes was limited. Conclusions: Current evidence is insufficient to establish the clinical efficacy of neurofeedback or biofeedback in adults with MS. Although some studies reported domain-specific improvements, confidence in these findings is limited by small samples, substantial methodological heterogeneity, and predominantly high risk of bias. Larger, methodologically rigorous studies with standardized protocols and longer follow-up are required before firm conclusions regarding effectiveness can be drawn.
Effects of neurofeedback and biofeedback on cognitive, affective, and motor outcomes in adults with multiple sclerosis: a systematic review
Lagravinese G.;Manippa V.;Farella A.;Scaramuzzi G. F.;
2026-01-01
Abstract
Background: Multiple sclerosis (MS) is associated with cognitive, affective, fatigue-related, and motor symptoms that may persist despite conventional management. Neurofeedback and biofeedback have been proposed as non-invasive interventions to support self-regulation and functional recovery, but their clinical value in MS remains unclear. Objective: To systematically review the effects of neurofeedback and biofeedback on cognitive, affective, and motor outcomes in adults with MS. Methods: PubMed, Scopus, Web of Science Core Collection, and PsycINFO were searched from inception to 7 April 2026 in accordance with a prospectively registered PROSPERO protocol (CRD420261339933). Interventional studies evaluating neurofeedback and/or biofeedback in adults with MS were eligible. Study selection was performed independently by three reviewers, whereas data extraction and risk-of-bias assessment were performed independently by two reviewers. Because of substantial heterogeneity in interventions, designs, and outcomes, findings were synthesized narratively. Results: Ten studies met the eligibility criteria. Neurofeedback studies reported improvements in depressive symptoms and selected cognitive outcomes in some samples, particularly in responder subgroups or combined treatment approaches, whereas biofeedback studies reported improvements in selected gait, balance, and postural outcomes. However, these findings were derived from a small and methodologically heterogeneous evidence base with substantial risk of bias and should therefore be interpreted cautiously. Findings for fatigue were mixed, and evidence for quality of life, sleep, and other secondary outcomes was limited. Conclusions: Current evidence is insufficient to establish the clinical efficacy of neurofeedback or biofeedback in adults with MS. Although some studies reported domain-specific improvements, confidence in these findings is limited by small samples, substantial methodological heterogeneity, and predominantly high risk of bias. Larger, methodologically rigorous studies with standardized protocols and longer follow-up are required before firm conclusions regarding effectiveness can be drawn.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
