Effects of neurofeedback and biofeedback on cognitive, affective, and motor outcomes in adults with multiple sclerosis: a systematic review.

In 30 seconds

This systematic review examined interventional studies of neurofeedback and biofeedback for cognitive, affective, and motor outcomes in adults with multiple sclerosis. Ten studies met the eligibility criteria; substantial variation in interventions, designs, and outcomes meant results were synthesized narratively. Some neurofeedback studies reported improvements in depressive symptoms and selected cognitive outcomes, while biofeedback studies reported gains in selected gait, balance, and postural outcomes. Fatigue findings were mixed, and evidence for other outcomes was limited. The authors concluded that current evidence is insufficient to establish clinical efficacy.

Key findings

• Ten studies met the review’s eligibility criteria.
• Some neurofeedback studies reported improvements in depressive symptoms and selected cognitive outcomes, particularly in responder subgroups or combined treatment approaches.
• Biofeedback studies reported improvements in selected gait, balance, and postural outcomes.
• Fatigue findings were mixed; evidence for quality of life, sleep, and other secondary outcomes was limited.

Why it matters

The review identifies possible domain-specific benefits but finds that the evidence is too uncertain to establish clinical efficacy in adults with MS. Small samples, methodological heterogeneity, and predominantly high risk of bias limit confidence in reported improvements. This distinction matters when interpreting promising outcomes: they support further investigation, not firm conclusions about effectiveness.

What to keep in mind

The evidence base comprised only ten studies and was small and methodologically heterogeneous, with substantial risk of bias. Findings were synthesized narratively, and follow-up was identified as an area requiring improvement.