Neurofeedback therapy for the management of multiple sclerosis symptoms: current knowledge and future perspectives

Abstract

Fatigue is a frequent and debilitating symptom in patients with multiple sclerosis (MS). Affective manifestations are also of high prevalence in this population and can drastically impact the patients’ functioning. A considerable proportion of patients with MS suffer from cognitive deficits affecting general and social cognitive domains. In addition, pain in MS is commonly observed in neurology wards, could be of different types, and may result from or be exacerbated by other MS comorbidities. These complaints tend to cluster together in some patients and seem to have a complex pathophysiology and a challenging management. Exploring the effects of new interventions could improve these outcomes and ameliorate the patients’ quality of life. Neurofeedback (NFB) might have its place in this context by enhancing or reducing the activity of some regions in specific electroencephalographic bands (i.e., theta, alpha, beta, sensorimotor rhythm). This work briefly revisits the principles of NFB and its application. The published data are scarce and heterogeneous yet suggest preliminary evidence on the potential utility of NFB in patients with MS (i.e., depression, fatigue, cognitive deficits and pain). NFB is simple to adapt and easy to coach, and its place in the management of MS symptoms merits further investigations. Comparing different NFB protocols (i.e., cortical target, specific rhythm, session duration and number) and performing a comprehensive evaluation could help developing and optimizing interventions targeting specific symptoms. These aspects could also open the way for the association of this technique with other approaches (i.e., brain stimulation, cognitive rehabilitation, exercise training, psychotherapies) that have proved their worth in some MS domains.

Neuroimaging and neuromodulation of invisible symptoms in multiple sclerosis

“…In addition, combining neuromodulation with other interventions might engender cumulative or synergistic effects. The choice of interventions would depend on the symptom in question and could include cognitive training (Benedict et al, 2020 ), neurofeedback (Ayache et al, 2021 ), psychotherapies (Sesel et al, 2018 ), physical exercise (Muñoz-Paredes et al, 2022 ), neurobiological methods (Hertenstein et al, 2021 ), interoceptive technologies (Schoeller et al, 2024 ), among others. Finally, coupling neuroimaging and neuromodulation would help unveil the underlying neuromodulation mechanisms.…”

Possible Mechanisms Underlying Neurological Post-COVID Symptoms and Neurofeedback as a Potential Therapy

“…BFB has been found to be capable of improving various neurological problems such as headaches (Walker, 2011), insomnia (Hammer et al, 2011), depression (Paquette et al, 2009;Tsuchiyagaito et al, 2021), fatigue (Hammond, 2001), epileptic seizures (Walker and Kozlowski, 2005) which overlap with the symptoms frequently found in post-COVID-19 conditions as well (Carroll et al, 2020;Dono et al, 2021;Guedj et al, 2021b;Kincaid et al, 2021;Lorkiewicz and Waszkiewicz, 2021;Park et al, 2021). Furthermore, NFB was found to be effective for treatment of chronic fatigue syndrome (CFS) (Hammond, 2001) and multiple sclerosis (MS) (Ayache et al, 2021) which both share similar symptoms to post-COVID-19 complications, such as pain, fatigue and depression (Workman et al, 2020;Komaroff and Lipkin, 2021;Wostyn, 2021). In addition, as well as in case of post-COVID-19 syndrome, both CFS and MS may stem from infectious agents (Steiner et al, 2001;Ghasemi et al, 2017;Komaroff and Lipkin, 2021).…”

Effect of neurofeedback therapy on neurological post-COVID-19 complications (A pilot study)

“…As a result, the brain associates the visual and auditory feedback of the NFB with the brain state rewarded by the NFB [ 18 – 20 ]. The clinical potential of NFB has already been documented in a number of psychiatric and neurological conditions such as anxiety [ 24 ], headaches [ 25 ], fatigue [ 26 ], sleep disturbances [ 27 ], cognitive functions [ 28 , 29 ], and others [ 30 , 31 ]. Because many of the above clinical conditions overlap to a huge extent with neurological symptoms after COVID-19, we hypothesized that NFB could improve neurological complications after COVID-19.…”