Neurofeedback for functional neurological disorders: future directions for research and clinical practice.

Abstract

Functional neurological disorder (FND) is increasingly conceptualized as a disorder of network-level dysfunction involving altered salience processing, impaired motor intention-execution coupling and disrupted self-agency. Despite advances in multi-disciplinary rehabilitation, a proportion of individuals experience persistent or fluctuating symptoms, highlighting the need for mechanistically informed adjunctive interventions. Neurofeedback, a closed-loop technique enabling individuals to modulate neural activity in real time, offers a theoretically grounded approach to targeting dysfunctional circuits implicated in FND. This opinion article synthesizes current neuroscientific models of FND with evidence from neurofeedback research in motor, affective and pain-related conditions. We examine modality-target considerations (e.g. electroencephalography versus functional magnetic resonance imaging), learning mechanisms including operant and associative paradigms and the relevance of network-based interventions for heterogeneous FND phenotypes. Given the limited direct evidence in FND, we critically appraise methodological variability in existing neurofeedback applications and outline pragmatic steps towards greater standardization, including transparent reporting of neural targets, feedback modality, training dose and transfer assessment. We also discuss translational challenges, including integration within established physiotherapy frameworks, patient-centred personalization and digitally enabled delivery models. While empirical evidence remains preliminary, neurofeedback represents a biologically informed and potentially scalable intervention that warrants systematic investigation within multi-disciplinary FND care pathways. This article is part of the discussion meeting issue 'Digital healthcare for the management of functional neurological disorders'.