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

First published online August 25, 2026. Across 10 small studies in adults with multiple sclerosis, some neurofeedback studies reported signals for depression or selected cognitive outcomes, while some biofeedback studies reported improvements in gait, balance or postural control. Fatigue findings were mixed. Because seven studies were at high risk of bias, three raised some concerns and the methods varied substantially, the review concluded that current evidence is insufficient to establish clinical effectiveness.

Lagravinese G, Manippa V, Farella A, Natale A, Todisco R, Aresta S, Guglielmo M, De Trane S, Fiore P, Scaramuzzi GF, Taurisano P.
Multiple Sclerosis and Related Disorders · Publication date: 2026-08-25
Added to site: 2026-11-04
DOI: 10.1016/j.msard.2026.107882

First published online August 25, 2026 and assigned to the November 2026 issue. PubMed records an August 26 electronic date; the journal full-text page records August 25. Added to Neurofeedback.com November 4, 2026 after comparison with fresh and reserve candidates. This is a historical addition, not a newly published November 4 study.

Modalities

EEG neurofeedback, Biofeedback, Rehabilitation

Clinical focus

Multiple sclerosis, Cognition and mood, Gait, balance and postural control

Population

Adults with multiple sclerosis represented in 10 interventional neurofeedback or biofeedback studies

Sample

10 studies; the review did not report one pooled participant denominator because interventions, designs and outcomes were substantially heterogeneous

Intervention / method

PubMed, Scopus, Web of Science Core Collection and PsycINFO were searched from inception through April 7, 2026 under PROSPERO CRD420261339933. Three reviewers independently selected studies; two independently extracted data and assessed risk of bias.

Comparator

Comparator conditions varied across the included studies, and some studies lacked a control or sham condition; heterogeneity prevented quantitative pooling

Clinician summary

The prospectively registered review used four databases and a narrative synthesis. Seven of 10 studies were judged high risk of bias and the remaining three raised some concerns. Domain-level certainty was low to very low. Positive signals were isolated, sometimes limited to responder subgroups or combined approaches, and evidence for fatigue, quality of life and sleep was mixed or sparse.

How to interpret the findings

The evidence base was small, methodologically heterogeneous and predominantly high risk of bias. Protocols, comparators, outcome measures, intervention doses and follow-up periods varied, and some studies lacked blinding or robust controls. No meta-analysis was appropriate, no single pooled participant denominator was reported and safety reporting was not consistent enough to establish a review-level adverse-event estimate. The findings do not support routine clinical implementation or generalization across all forms of neurofeedback, biofeedback or multiple-sclerosis symptoms.

Equipment and disclosures

The review spans multiple protocols and does not establish superiority for any commercial system. No equipment is attributed to BrainMaster or another vendor.

Partially supported by the Ricerca Corrente scheme of the Ministry of Health, Italy; the authors stated that the funder had no role in the review or publication decision. They declared no known competing financial interests or personal relationships. The paper disclosed ChatGPT use for language editing followed by author review and responsibility for the final content. No correction, retraction or expression-of-concern relation appeared in the checked PubMed, Crossref and bounded DOI/title records on November 4, 2026. AI-assisted source review for Neurofeedback.com, not independent human clinical review.

Related evidence

Compare findings from the same clinical area, including mixed results.