Human brain maturation and aging are highly nonlinear, yet their organization at the level of large-scale electrophysiological activity remains poorly understood. We analyzed resting-state electroencephalography (EEG) recordings from 1,763 healthy individuals aged 5-85 years to map lifespan trajectories across spectral, complexity, and morphological features. Age-sensitive features clustered into distinct nonlinear trajectories, most commonly showing rapid change during childhood and adolescence followed by stabilization in adulthood, while a smaller subset exhibited turning points in midlife. These trajectories also differed in their spatial expression, ranging from highly conserved scalp-wide patterns to heterogeneous profiles in which the same feature followed distinct trajectories across scalp regions. Transition ages revealed recurring regional sequences, suggesting that diverse EEG features share common reorganization chronologies. Together, these results show that lifespan EEG variation is structured through complementary temporal trajectories, spatial architectures, and regional transition sequences. This normative framework provides a basis for investigating brain development and aging and for identifying atypical patterns associated with neurological and psychiatric disorders.

Introduction Les maladies neurodégénératives (MND), en forte progression, représentent un enjeu majeur de santé publique. Une prise en charge palliative précoce est essentielle, et les pharmaciens d’officine pourraient jouer un rôle clé encore peu défini. Objectifs L’objectif est d’évaluer les connaissances et pratiques des pharmaciens d’officine concernant la prise en charge de la fin de vie des patients atteints de MND, via un questionnaire analysant leurs pratiques professionnelles. Méthodes Interroger par le biais d’un questionnaire anonyme les pharmaciens d’officine (titulaire et adjoint) au sein du territoire français. Résultats Parmi les 56 pharmaciens interrogés, 61,8 % ne se sentent pas toujours à l’aise lors de la dispensation aux patients en phase terminale de MND. Les difficultés rapportées incluent l’absence d’anticipation (54,5 %), le manque de temps pour la communication et la coordination (69,1 %) et une connaissance limitée des dispositifs médicaux (58,2 %). La communication interprofessionnelle apparaît insuffisante, les informations provenant majoritairement des aidants (74,5 %). Discussion Les pharmaciens d’officine jouent un rôle encore limité dans la prise en charge terminale à domicile des patients atteints de MND. Le manque de connaissances législatives, médicales et pratiques, associé à une communication interprofessionnelle insuffisante et à un déficit de formation relationnelle, freine l’anticipation et l’accompagnement. Renforcer la formation apparaît essentiel pour améliorer la prise en charge des patients à domicile. Conclusion Ce travail ouvre la voie à une réflexion sur l’optimisation du rôle du pharmacien dans les soins palliatifs à domicile, en soulignant l’importance de la coordination interprofessionnelle, de la gestion thérapeutique et du soutien global aux patients et à leurs proches.

The objective of this opinion paper is to highlight, based on recent studies, the importance of considering motor symptom (a)symmetry in the progression and management of non-motor symptoms in Parkinson’s disease.

Introduction Les traitements par dispositifs (device-aided therapies, DAT) ont un bénéfice clinique démontré dans la maladie de Parkinson (MP). Des disparités d’accès ont cependant été mises en évidence à l’international. Objectifs Evaluer l’accès et l’utilisation des DAT dans la MP en France sur une période allant de 2015 à 2021, en ayant recours au Système National des Données de Santé (SNDS). Méthodes Les données ont été collectées rétrospectivement à partir du SNDS. L’incidence de l’initiation d’un DAT chez les patients parkinsoniens a été calculée pour chaque année de la période d’étude. Les incidences ont également été calculées par année et par région. Les taux d’incidence ont été standardisés selon les classes d’âge (tous les 10 ans) et selon le sexe.Résultats 8829 patients (âge moyen 68,7±10,3 ans ; 43,4 % de femmes) ont bénéficié d’un premier DAT entre 2015 et 2021 (+41,8 %). Parmi eux, 6873 ont débuté une pompe à apomorphine (+58,9 %), 1 592 une stimulation cérébrale profonde/SCP (–20,7 %) et 364 une Duodopa (+152,9 %). Les prescripteurs principaux sont les centres hospitaliers (74,6 %), non limités aux centres experts Parkinson. Une faible proportion de changements ou de combinaisons de DAT est observée. La cartographie régionale suggère des disparités d’accès. Discussion Contrairement aux autres pays, où le DAT le plus utilisé est la SCP ou Duodopa, le DAT le plus fréquemment initié et utilisé en France entre 2015 et 2021 est la pompe à apomorphine, dans des proportions inédites, tandis que l’utilisation de la SCP est en diminution. Conclusion Les spécificités du système de santé français (taux de remboursement, disponibilité de prestataires infirmiers à domicile) pourraient expliquer cette distribution.

Background and objectives:Device-aided therapies (DAT) have significantly improved the management of Parkinson's disease (PD). They now include deep brain stimulation (DBS), levodopa-carbidopa intestinal gel (LCIG) infusion, continuous subcutaneous apomorphine infusion (CSAI), subcutaneous foslevodopa/foscarbidopa and levodopa-entacapone-carbidopa intestinal gel (LECIG) infusions. Despite established clinical benefits, disparities in DAT access and use have been reported across Europe and the USA. The PARKinson's Device-Aided-Therapies (PARK-DAT) study aimed to evaluate access to and use of DAT (DBS, LCIG and CSAI) for PD in France between 2015 and 2021 using data from the French national administrative healthcare database (Système National des Données de Santé, SNDS). Methods:PARK-DAT is a nationwide, retrospective observational study. Patients with PD who initiated any DAT for the first time between 2015 and 2021 were identified using an established algorithm and codes within the SNDS. Standardised incidences of DAT initiation were calculated by study period and geographical region. Results:Between 2015 and 2021 8829 patients with PD (mean age 68.7±10.3 years; 43.4% women) initiated DAT representing a 41.8% overall increase between 2015 and 2021. CSAI was the most frequently initiated therapy (6873 patients; +58.9%), followed by DBS (1592 patients; -20.7%) and LCIG (364 patients; +152.9%). Most DAT prescriptions originated from hospital centres (74.6%). Few therapy switches or combinations were observed, mainly involving CSAI. Regional analyses suggest incidence disparities in DAT access. Discussion:Unlike patterns observed in other countries, CSAI was the predominant DAT in France, while DBS use declined. Features of the French healthcare system, including favourable reimbursement and broad access to home nursing services, may account for this distinctive distribution.

Introduction Les troubles du contrôle des impulsions (TCI) représentent une complication comportementale fréquente chez les patients atteints de la maladie de Parkinson, traités par agonistes dopaminergiques. Le repérage précoce de ces troubles est essentiel. Objectifs Réaliser un état des lieux des connaissances et pratiques des pharmaciens en lien avec les TCI dans la maladie de Parkinson. Méthodes Questionnaire en ligne (Framaforms) adressé aux pharmaciens d’officine diplômés et exerçant en France et disponible du 20 novembre 2024 au 25 mars 2025. Résultats Cent pharmaciens ont répondu au questionnaire. Quarante-trois pour cent ne connaissent pas l’existence des TCI, et seuls 34 % savent quels traitements antiparkinsoniens sont associés à des TCI. Soixante-dix pour cent des pharmaciens n’informent pas les patients parkinsoniens de la survenue possible des ces effets indésirables lors de la délivrance des traitements, bien que 94 % des pharmaciens pensent qu’il est de leur rôle d’alerter s’ils suspectent un cas de TCI chez un patient. Discussion Le manque de connaissances apparaît comme l’obstacle principal qui empêcherait les pharmaciens d’évoquer les TCI avec les patients. Plus de la moitié des pharmaciens ayant répondu au questionnaire ne sont pas en contact avec un autre professionnel de santé concernant leurs patients parkinsoniens. Seulement 5 % disent être en contact avec un neurologue, ce qui montre la difficulté d’établir une communication avec des spécialistes. Conclusion En pratique, les TCI sont peu abordés en officine. Des actions correctrices sont à mener, en lien avec les équipes de neurologie, pour améliorer l’information des patients, le dépistage précoce des TCI et la collaboration interprofessionnelle.

Parkinson's disease (PD) is now recognized as a multisystem, heterogeneous neurodegenerative disease with fluctuating trajectories and complex symptom profiles. Despite therapeutic advances, many patients (particularly women and those in late stages) and their caregivers face substantial unmet needs across physical, psychological, social, and spiritual domains, which highlight the need for a more integrative care model. Palliative care, defined as holistic, person-centered care for individuals with life-limiting illnesses, is increasingly recognized as particularly relevant in PD, from early to terminal stages. However, its implementation in neurology remains limited, notably due to persistent misconceptions, and delayed or absent referrals. This narrative review therefore aims to equip PD care teams with a clearer understanding of palliative care principles and their applicability to PD, by synthesizing emerging evidence in neuropalliative care, and providing practical recommendations for integration into routine neurological practice. Building on the specificities of quality of care for chronic conditions, optimal neuropalliative care in PD involves regular (re)assessment of symptoms and priorities, effective management of the chronic-palliative interface, good communication, continuity of care (including neurological care until the end of life), and a multidisciplinary network of professionals working both in the community and in specialized clinics, while leaving room for the involvement of caregivers. Far from being "the end of the road", neuropalliative care is a strategic and compassionate response to the evolving complexity of PD, which ultimately enhances quality of life, supports families, and reinforces the neurologist's pivotal role in longitudinal, person-centered care.

Parkinson’s disease is the second most common neurodegenerative disorder. In advanced Parkinson’s disease, subcutaneous (SC) infusion therapies represent minimally invasive and reversible treatment options. In the United Kingdom (UK), licensed SC infusion therapies include apomorphine and foslevodopa–foscarbidopa; both represent effective and generally well-tolerated therapies, although uncertainties regarding their relative efficacy, safety and costs remain. The relative efficacy and safety of apomorphine and foslevodopa–foscarbidopa was assessed via Bucher indirect treatment comparison (ITC) of TOLEDO (NCT02006121) and M15-736 (NCT04380142) data, with findings used to support a cost-minimisation analysis (CMM). Thirteen outcomes were evaluated. Efficacy and safety outcomes were measured as mean differences and risk differences, respectively. The CMM, conducted from a UK healthcare payer perspective, considered treatment acquisition and concomitant therapy costs over a 6.34-year horizon (obtained from a published observational study). Bucher ITC results provided evidence for a comparable efficacy for apomorphine and foslevodopa–foscarbidopa in advanced Parkinson’s disease. ITCs also indicated comparable safety, although a trend in favour of apomorphine was identified for hallucinations and most infusion site reactions assessed. The CMM demonstrated a clear per-patient cost benefit for apomorphine versus foslevodopa–foscarbidopa (£120,173.70), primarily driven by lower drug acquisition costs. The main difference between UK licensed SC infusion therapies for advanced Parkinson’s disease relates to cost as opposed to clinical outcome, with some evidence for improved tolerability of apomorphine. This supports the continued use of apomorphine as first-line SC infusion treatment for advanced Parkinson’s disease in UK clinical practice.

Neurodegenerative diseases like Parkinson’s (PD) and Alzheimer’s (AD) exhibit considerable heterogeneity of functional brain features within patients, complicating diagnosis and treatment. Here, we use electroencephalography (EEG) and normative modeling to investigate neurophysiological mechanisms underpinning this heterogeneity. Resting-state EEG data from 14 clinical units included healthy adults (n = 499) and patients with PD (n = 237) and AD (n = 197), aged over 40. Spectral and source connectivity analyses provided features for normative modeling, revealing significant, frequency-dependent EEG deviations with high heterogeneity in PD and AD. Around 30% of patients exhibited spectral deviations, while ~80% showed functional source connectivity deviations. Notably, the spatial overlap of deviant features did not exceed 60% for spectral and 25% for connectivity analysis. Furthermore, patient-specific deviations correlated with clinical measures, with greater deviations linked to worse UPDRS for PD (⍴ = 0.24, p = 0.025) and MMSE for AD (⍴ = −0.26, p = 0.01). These results suggest that EEG deviations could enrich individualized clinical assessment in Precision Neurology.

ABSTRACT Neuroscience research has shown that specific functional brain patterns can be related to creativity during multiple tasks but also at rest. Nevertheless, the electrophysiological correlates of a highly creative brain remain largely unexplored. This study aims to uncover resting-state networks related to real-life creativity using high-density electroencephalography (HD-EEG) and to test whether the strength of functional connectivity within these networks could predict individual creativity. We acquired resting-state HD-EEG data from 90 participants who completed a creativity questionnaire. We then employed connectome-based predictive modeling; a machine-learning technique that predicts behavioral measures from brain connectivity features. Using a support vector regression, our results revealed functional connectivity patterns related to high and low creativity in the gamma frequency band. In leave-one-out cross-validation, the combined model of high and low creativity networks predicted creativity scores with very good accuracy (r= 0.34, p= 0.0009). Furthermore, the model’s predictive power was established by an external validation on an independent dataset (N= 41), where we found a statistically significant relationship between the observed and predicted creativity scores (r= 0.37, p= 0.01). These findings reveal large-scale networks that could predict individual real-life creativity at rest, providing a crucial foundation for developing EEG network-based markers of creativity.

Apomorphine is now recognised as the oldest antiparkinsonian drug on the market. Though still underused, it is increasingly prescribed for patients with advanced Parkinson's disease (PD) with motor fluctuations in Europe, Asia and more recently on the other three continents. In light of its most recent uses and newest challenges, this paper focuses on a number of indications in Parkinson's disease and beyond, which are currently under development or which would benefit from development, given the generally high levels of evidence: sedation and sleep disorders, withdrawal of oral dopaminergic medication, palliative care, restless legs syndrome, traumatic brain injury and sexual dysfunction.

The link between subthalamic nucleus deep brain stimulation (STN-DBS) and apathy in patients with Parkinson's disease (PD) remains a controversial topic. The literature is mixed and the most supported explanation is the reduction of dopaminergic treatment. Yet a body of clinical and experimental evidences suggest that STN-DBS itself can also promote apathy in certain patients. However, the parameters accounting for apathy heterogeneity in stimulated patients along with the mechanisms underlying apathy induced by STN-DBS remain to be investigated. Whether bilateral and unilateral STN-DBS have the same influence on apathy is for instance unknown. We previously and separately showed in patients and rodents that bilateral STN-DBS can promote apathy per se. Here, we compare the effect of bilateral versus unilateral STN-DBS both in patients and in rodents. We conducted a clinical follow-up of patients with Parkinson's disease undergoing unilateral or bilateral STN-DBS and assessing apathy 3 months before and after STN-DBS. In parallel, we applied chronic and uninterrupted unilateral or bilateral DBS in rodents and extract longitudinal motivational changes with a battery of behavioural tests. While bilateral STN-DBS promotes apathy in patients and induces a loss of motivation in rodents, we found that unilateral STN-DBS did not exert such an effect both in patients and in rats. These data show that bilateral but not unilateral STN-DBS promotes apathy. This not only substantiate the induction of neuropsychiatric effects by STN-DBS but also suggest that this might be circumvented if STN-DBS is applied unilaterally instead of bilaterally.