Multiple sclerosis (MS) is a chronic autoimmune disease of the central nervous system (CNS)
characterized by inflammation, demyelination, gliosis, and neuronal loss. Neurological
symptoms may include visual disturbances, numbness and tingling, focal weakness, bladder and
bowel incontinence, and cognitive impairment. Some previous studies have indicated that the
NeuroBiofeedback (NBF) technique could be a promising new treatment for the rehabilitation of
many neurological disorders and neurodegenerative diseases, including MS. Several studies
have investigated the beneficial effects of this technique on the motor and cognitive
outcomes of MS, mainly aiming to evaluate motor performance, fatigue and chronic pain. Few
studies have focused on the evaluation and treatment of cognitive processes with NBF, except
for one study on information processing speed. Specifically, regarding the application of NBF
techniques in MS, recent literature has demonstrated that modulation of the alpha-theta
rhythm has led to an improvement in attentional processes with consequent reduction in
anxiety. Therefore, the objective of this study is to verify the effectiveness of NBF
training on the modulation of cortical activity and physiological responses through the
exposure of subjects with MS to cognitive tasks and training for mood regulation.
Patients will not undergo an experimental procedure as foreseen by the study; the clinical
and neuropsychological variables that will be collected for the study are those that are
commonly collected by the neuropsychologist, in particular the main neuro-cognitive functions
(memory, language, attention and executive functioning) and emotional abilities (meta
cognition) will be considered. After enrollment, the clinical background and baseline
characteristics of patients will be assessed. Enrolled patients will be randomly assigned to
IG and SG. After randomization, patients will undergo instrumental examinations and
neuropsychological evaluation, as required by the protocol. Patients in both groups will
undergo 2 neurofeedback training sessions. All recruited subjects will be evaluated at two
time-points: a first evaluation at baseline (T0) and at the end of the training (T1).
Patients will undergo stimulation training via NBF 2 times a week for two months, for a total
of 16 sessions. The procedure and execution of the training requires that the subjects are
connected to a series of electrodes that will record the cortical electrical activity. During
each session, IG patients will view their recorded brain waves and physiological responses in
front of a computer screen, while a professional will explain to them what they need to do to
intervene on what they see, in order to correctively modify their brain waves. While SG
patients will be provided with irrelevant information (recorded data from other patients) and
therefore will not be able to modulate their cortical activation