On 11 March 2020, a national lockdown was imposed by the Italian government to contain the spread of COVID19 disease. This is an observational longitudinal study conducted at Fondazione Stella Maris (FSM), Italy to investigate lockdown-related emotional and behavioural changes in paediatric neuropsychiatric population. Families having children (1.5–18 years) with neuropsychiatric disorders referred to FSM have been contacted and proposed to fulfil two online questionnaires (General questionnaire and Child Behaviour Check List (CBCL)) to (i) compare (paired two-sample t-tests) the CBCL scores during lockdown with previous ones, and (ii) investigate the influence (multiple linear regression models) of variables such as age, diagnosis grouping (neurological, neurodevelopmental, emotional, and behavioural disorders) and financial hardship. One hundred and forty-one parents fulfilled the questionnaires. Anxiety and somatic problems increased in 1.5–5 years subpopulation, while obsessive-compulsive, post-traumatic and thought problems increased in 6–18 years subpopulation. In the regression models, younger age in the 1.5–5 years subpopulation resulted as “protective” while financial hardship experienced by families during lockdown was related to psychiatric symptoms increasing in the 6–18 years subpopulation. Some considerations, based on first clinical impressions, are provided in text together with comments in relation to previous and emerging literature on the topic.

Epilepsy is a cortico-subcortical network disease. Thalamo-cortical relationships in focal epilepsies, studied by stereoelectroencephalography in complex patients during pre-surgical evaluation, might help refine epilepsy surgery prognostic indicators and patient-specific treatments (i.e. thalamic deep brain stimulation). To this aim, we studied interictal thalamic traces, during rest and sleep recordings, in a cohort of 121 patients, delving into thalamo-cortical connectivity, hyperexcitability biomarkers and their correlation with treatment outcome. We retrospectively gathered stereoelectroencephalography recordings and clinical variables from patients who underwent stereoelectroencephalography with mainly a posterior-thalamic implantation, aiming at the pulvinar. Interictal recordings during rest and sleep were analysed to detect spikes and fast ripples automatically. Functional connectivity between the thalamus and other brain regions (involved or non-involved in the epileptogenic network) was examined using linear regression analysis. Higher thalamic hyperexcitability biomarker rates during sleep were linked to unfavourable surgical outcomes (Engel Class III/IV) compared to favourable outcomes (Engel Class I/II) (spikes: N = 117, P = 0.009, effect size = 0.25; fast ripples: N = 17, P = 0.036, effect size = 0.52). Thalamo-cortical functional connectivity analysis revealed heightened thalamic strength, particularly in the beta (P < 0.001, effect size = 0.38) and gamma (P = 0.012, effect size = 0.24) bands during sleep, among patients with poor surgical outcomes, especially with non-involved networks. Conversely, during rest, lower hyperexcitability biomarkers (spikes r = −0.2, P = 0.048; fast ripples r = −0.52, P = 0.045) and lower values of thalamic strength (delta band r = −0.28, P = 0.025; broadband r = −0.23, P = 0.01) were observed in patients with longer epilepsy duration. Furthermore, thalamic strength values during rest were lower in patients of older age (broadband r = −0.19, P = 0.045). These findings confirmed the important role of the thalamus in focal epilepsy. According to this exploratory group-level study, thalamic recordings could potentially improve pre-surgical assessment and help identify patients who may have a less severe outcome. Additionally, diminished thalamic activity and connectivity associated with epilepsy duration and age prompt speculation on the role of thalamo-cortical interactions in ageing-related physiological and pathological processes.

Neurological injury remains a major cause of neurodevelopmental morbidity in preterm-born infants. Accurate prognostication is essential for support of families and to target interventions. Electroencephalography (EEG) and magnetic resonance imaging (MRI) can be used to precisely assess brain function and structure in preterm infants. This systematic review assessed the prognostic capacity of EEG and MRI alone, and in combination, for the prediction of neurodevelopmental outcomes in preterm-born infants. PubMed, Embase, Web of Science, and Cochrane databases were searched from inception until April 22, 2025. Studies were included if they examined the use of both MRI and EEG in preterm-born infants to predict neurodevelopmental outcomes. From 1669 records screened, 12 studies reporting 1630 infants were included in the systematic review. Of these 12, seven were sufficiently homogenous for quantitative meta-analysis, yielding pooled sensitivity and specificity values across 952 infants: EEG prognosticated abnormal neurodevelopmental outcomes with sensitivity 64% (95% confidence interval [CI] 48-80%) and specificity 70% (95% CI 59-81%); MRI prognosticated abnormal neurodevelopmental outcomes with sensitivity 64% (95% CI 48-80%) and specificity 89% (95% CI 81-97%). Three of these seven studies, reporting 372 infants, were sufficiently comparable to meta-analyze the combination of EEG and MRI, which predicted neurodevelopmental outcome with sensitivity 70% (95% CI 49-90%) and specificity 96% (95% CI 93-100%). The combined use of EEG and MRI can predict abnormal neurodevelopment in preterm-born infants with high sensitivity and specificity and was superior to either test in isolation; however, data are limited as multimodal neurological-assessment is still an emerging practice in neonates.

Objective To assess the predictive accuracy of early neurophysiological and neuroimaging biomarkers, alone and in combination, for adverse neurodevelopmental disorders in term-born infants with neonatal encephalopathy (NE). Design Systematic review and meta-analysis conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses of Diagnostic Test Accuracy guidelines. Eligible studies included infants born at term with NE who underwent amplitude-integrated EEG (aEEG) or EEG and MRI of the brain within the first month of life. Adverse outcomes, assessed at 18–36 months of age, were defined as cerebral palsy, postneonatal epilepsy, severe hearing or visual impairment, moderate-to-severe developmental delay, or death attributable to NE. Searches were conducted in MEDLINE, CINAHL, Embase and Web of Science from database inception to 10 June 2025; risk of bias of included studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies-Comparative (QUADAS-C) tool. Main outcome measures Sensitivity, specificity and diagnostic odds ratio (DOR) of abnormal aEEG background, EEG background, EEG seizures and MRI injury, individually and in combination, for predicting adverse outcomes, pooled using Bayesian bivariate random effects meta-analyses. Results 27 studies including 1843 infants were analysed. MRI injury was the individual predictor with higher DOR estimate (31.01, 95% CI 15.07 to 72.82), followed by abnormal EEG background (16.84, 95% CI 5.88 to 50.59), while abnormal aEEG background and EEG seizures performed less well (7.99, 95% CI 2.40 to 33.00; 4.46, 95% CI 1.86 to 11.42). Combining EEG background with MRI injury improved DOR (78.59, 95% CI 19.72 to 321.36) and specificity (93.8%, 95% CI 85.2% to 97.9%) compared with MRI alone. Conclusions MRI is a strong individual predictor of adverse outcomes in NE. Combining it with early EEG improves prognostic accuracy and may better support clinical decision-making. PROSPERO registration number CRD42024585816.

Early identification of neurodevelopmental risk in very preterm infants is critical for timely intervention. The Kidokoro MRI scoring system offers a semi-quantitative approach to evaluating brain abnormalities. This study aimed to assess the agreement of Kidokoro scores obtained in the same infants at 32- and 40-weeks postmenstrual age, and their association to cognitive, language, and motor outcomes at 24 months corrected age. A cohort of 187 very preterm infants (median 28⁺⁵weeks gestational age; 55% male) underwent structural MRI at two timepoints: Early (median 32⁺²weeks) and Term-Equivalent Age (median 40⁺⁵weeks), using 3 T scanners. Scans were scored independently using a modified version of the Kidokoro system. Bland-Altman analysis assessed agreement between Early and term equivalent age scores. Neurodevelopmental outcomes were assessed at 24 months using the Bayley-III. Multivariable linear regression models evaluated the predictive value of MRI scores, adjusting for sex, gestational age, birthweight centile, and socioeconomic status. Early MRI scores were consistently higher than term equivalent age scores (mean difference 1.9; 95%CI: 1.6-2.2), with white matter scores showing the largest discrepancy (mean difference 1.68; 95%CI: 1.46-1.90), primarily due to the "myelination delay" item. Excluding this item reduced the difference to 0.32 (95%CI: -0.01 to 0.64). Early and TEA Kidokoro global brain abnormality score (GBAS) were negatively associated with Bayley-III cognitive and motor, but not language scores. Higher GBAS were associated with lower cognitive (Early: β= -0. 67, 95%CI: -1.23 to -0.11; Partial R²=0.03; TEA: β= -0.60 95%CI: -1.15 to -0.06, Partial R²=0.03) and motor scores (Early: β= -1.04, 95%CI: -1.67 to -0.41, Partial R²=0.06; TEA: β= -1.18, 95%CI: -1.78 to -0.58, Partial R²=0.08). Reduction in GBAS from Early to TEA correlated with higher motor scores (β=1.02, 95%CI: 0.03 to 2.02, Partial R²=0.02). White matter abnormalities were linked to poorer motor outcomes at both timepoints. Kidokoro scores at early and term-equivalent timepoints are associated with neurodevelopmental outcomes at 24 months. Global abnormalities and white matter scored at either timepoints, or their longitudinal changes are significantly linked to motor outcomes. Refinement of scoring system for the early assessment may enhance clinical utility. The authors declare no conflicts of interest related to the content of this article.