BACKGROUND: Music- and dance-based rehabilitation has gained prominence in promoting social engagement and improving motor, cognitive, and mood domains in individuals affected by different neurological disorders. AIM: This systematic review aims to synthesize existing evidence from randomized controlled trials (RCTs) investigating neuroimaging-based structural and functional neuroplasticity following music- and dance-based interventions among people with neurological disorders. METHODS: Literature research was performed using PubMed (MEDLINE), Scopus, and Web of Science (WOS). A multidimensional approach was employed to assess the efficacy of music- and dance-based interventions, integrating neuroimaging and clinical assessments. RESULTS: Out of a total of 2247 papers reviewed, 20 RCTs met the inclusion criteria for this review, with a total of 718 subjects. Among them, 88% underwent a neuroimaging investigation to evaluate structural or functional neuroplasticity. Six studies involved dance-based interventions, while 14 examined music-based rehabilitation. These interventions targeted cognitive, motor, and mood impairments in people at risk of dementia or with neurological disorders including Huntington's Disease, stroke, traumatic brain injury, spinal cord injury, and disorder of consciousness. DISCUSSION: Overall, the selected studies demonstrated significant effects on behavioral and neuroimaging outcomes, showing structural and functional changes in critical areas for perception and memory in patients at risk of dementia, as well as in regions essential for language processing, emotional regulation, and motor control in patients with acute and chronic stroke. Nevertheless, several biases were identified, specifically related to neuroimaging biomarkers, such as a lack of baseline and between-group comparisons and a lack of prior registration of neuroimaging biomarkers investigated. The protocol of this review was registered in the International Prospective Register of Systematic Reviews (PROSPERO), with registration number CRD42024574754.