115 Neural effects of deep brain stimulation on reward and loss anticipation and food viewing in anorexia nervosa: a pilot study Limitations of our study include the small sample size, which is a result of the highly specific setting and population of the study (an experimental intervention study in physically compromised patients), leading to very low power. Moreover, the food viewing task was even more underpowered due to the lack of a control group, which precluded testing for group x time interactions. Due to the small sample we were unable to link changes in activation patterns to clinical effect, symptoms and/or behavior. Future directions To gain more insight into the involvement of the reward circuitry in the etiopathogenesis and treatment of AN, larger neuroimaging studies should be conducted. It is also of great importance to develop ways to link neuroimaging data to clinical/behavioral data. Future studies on DBS in AN should include (functional) neuroimaging using more disease-specific tasks to better understand the differences in reward response to clinical features of AN. This could contribute to the knowledge of the etiopathological mechanisms in AN and the functional effects of DBS. Forming an international collaboration to conduct fMRI on a larger group of AN patients treated with DBS or a transdiagnostic approach comparing DBS in AN with DBS in OCD or MDD would be valuable for investigating possible individualized DBS-targeting. Conclusion The aim of our fMRI study was to investigate the effects of reward-circuitry targeted DBS in AN patients. We conducted functional MRI scans pre and post DBS and found differences in the response of reward-related brain areas post DBS. This supports the hypothesis that the reward circuitry is involved in the pathogenesis of anorexia nervosa and that DBS influences aberrant network activity. Further neuroimaging studies on DBS in AN with larger sample sizes, a more disease-specific paradigm, and a sham control condition should be considered.
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