The Bereitschaftspotential in Voluntary Movement and Movement Disorders: Potential, Limitations and New Perspectives

The Bereitschaftspotential (BP) represents one of the most distinctive neurophysiological markers of human voluntary action. Detectable from the scalp, it emerges prior to movement onset and primarily reflects the activity of motor and premotor cortical areas. Beyond its physiological relevance, the BP has been employed to investigate motor planning, volition, and movement initiation, with important applications in movement disorders and neurorehabilitation. However, the BP remains a challenging tool: its characteristics are influenced by the type and localization of movement, and methodological variability across studies limits comparability and its clinical interpretability. In this review, we synthesize current evidence on BP morphology, spatial distribution, and neurophysiological generators in healthy subjects and in patients with movement disorders. We examine methodological factors affecting its acquisition and interpretation and discuss its relationship with cerebello-thalamo-cortical and basal ganglia networks. By integrating physiological, clinical, and methodological perspectives, we propose a refined framework for interpreting the BP as a dynamic and network-dependent marker of voluntary motor control, highlighting its relevance for understanding movement disorders and improving its translational utility.