113 Neural effects of deep brain stimulation on reward and loss anticipation and food viewing in anorexia nervosa: a pilot study Figure S1 (supplementary material) illustrates that the ROI in the ventral striatum is located outside the regions that are affected by signal dropout from the DBS electrode. Food viewing task - No significant interactions were found between the conditions of high-calorie and low-calorie food images. Therefore, both conditions were combined as one food condition for further comparisons. Additionally, no significant interactions were found between the different time points, indicating that we did not find evidence for altered responses for food viewing between the pre- and post-DBS time points. DISCUSSION The present study investigated the neurobiological effects of vALIC DBS in AN patients using two tasks: the monetary incentive delay task and a food viewing task. The monetary incentive delay task was usedto study non-illness-specific food related reward-processing, while the food viewing task focused on more illness-specific reward processing. We hypothesized that AN-patients would show higher activation than HCs in reward-related brain areas during the monetary tasks pre-DBS, especially with losses -indicative of the heightened sensitivity to punishment in AN- and that this activation would normalize following DBS. We expected to find similar effects in the illness-specific task. In contrast to other studies (21, 22), we did not observe differences between AN patients and controls at baseline. However, we did find changes in the frontostriatal circuit during reward and loss anticipation in AN patients, with a decrease in right precuneus, right putamen and right VS activation, and an increase in mOFC activation following DBS. Conversely, increases in activation were seen in the HC group over time. These findings indicate a difference in response in het AN group after treatment with DBS. The VS mediates reward, reinforcement and motivational salience. In response to both monetary and visual food cues, AN patients show hypoactivity of the striatum (36). Our hypothesis was that in AN, there would be hyperactivity of the reward system in response to illness-compatible cues (including punishment) and less increased activity of the reward system in response to immediate rewards. The decreased activation of the right VS following DBS suggests a normalization of aberrant hyperactivity of the VS to reward and punishment, possibly indicating restoration of goal-directed rather than illness-compatible behavior. The mOFC, a subregion of the ventromedial prefrontal cortex, is linked to cognitive flexibility and context-specific responding, encoding emotional and reward value in decision-making. The fact that we found an increase in mOFC activation following DBS seems contradictory to the hypothesis that excessive cognitive control would decrease after treatment. One possibility is
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