Neurofeedback as an emerging rehabilitation strategy for Parkinson's disease: a narrative review

Parkinson's disease (PD) is a progressive neurodegenerative disorder characterized by motor and non-motor symptoms associated with dysfunction of cortico-basal ganglia-thalamo-cortical networks. Because current treatments remain largely symptomatic, there is increasing interest in adjunctive rehabilitation strategies capable of targeting disease-relevant neural activity more directly. Neurofeedback (NF), delivered through electroencephalography (EEG), functional magnetic resonance imaging (fMRI), or deep brain stimulation (DBS)-guided platforms, has emerged as a potential self-regulation-based neuromodulatory approach in PD.

This narrative review aimed to summarize the current empirical evidence on neurofeedback in Parkinson's disease, with particular attention to neurophysiological feasibility, reported clinical effects, and methodological and translational challenges.

A narrative review of the literature was conducted using PubMed, Scopus, Web of Science, and Google Scholar. Empirical studies published in English between 2002 and 2026 investigating EEG-based, fMRI-based, or DBS-guided neurofeedback in patients with idiopathic PD were considered. The review qualitatively synthesized findings related to neural target modulation and motor and non-motor outcomes.

Eighteen empirical studies were identified, across EEG-based, fMRI-based, and DBS-guided neurofeedback paradigms. EEG-based protocols represented the largest body of evidence and suggested that at least some patients with PD can achieve partial self-regulation of cortical targets such as sensorimotor rhythms, mu/beta activity, and movement-related cortical potentials. However, associated clinical effects were heterogeneous and generally preliminary. fMRI-based studies supported the feasibility of regulating disease-relevant motor regions and connectivity-based targets, including the supplementary motor area and basal ganglia-related networks, but consistent clinical superiority over active control conditions has not been established. DBS-guided neurofeedback provided the strongest pathophysiological specificity, showing that implanted patients can voluntarily modulate subthalamic beta activity, with preliminary evidence of benefit in selected movement-related outcomes. Across modalities, neurophysiological feasibility appeared more consistently supported than robust clinical efficacy.

Neurofeedback represents a promising and mechanistically grounded adjunctive rehabilitation strategy for Parkinson's disease. Current evidence indicates that self-regulation of disease-relevant neural signals is feasible in at least a subset of patients, but clinical effectiveness remains uncertain because of small samples, methodological heterogeneity, and limited replication. Future research should prioritize standardized protocols, adequately powered randomized trials, longer follow-up, and better integration of neurofeedback with established pharmacological, rehabilitative, and device-based treatments.