124 Chapter 6 that form a so-called robust rich-club (22, 23). Network measures further reflect optimality of the network organization, specifically the level of organization (inversely related to disorganisation and randomness of the network) and integration (reflecting the level of information exchange in the brain network). We expect that DBS affects the communication between brain and therefore network organization. The combined data allowed for both between-subject comparisons and within-patient change in brain network organization. We hypothesized that DBS causes changes in electrophysiological power spectra over time, and influences global graph parameters that describe optimization of communication within in the functional brain network. METHODS Study design As described previously (1) we conducted this study at the departments of psychiatry and neurosurgery of the Amsterdam University Medical Centers (Amsterdam UMC) location Academic Medical Center (AMC). The Medical Ethical Committee (MEC) of the Amsterdam UMC approved the study (METC AMC: 2012_169). We used an open label intervention clinical trial design, with the additional comparison of baseline pre-DBS values of patients to a matched control group in a patient-control design. Participants We recruited patients from the major clinics specialized in adult eating disorders in the Netherlands. We applied the following inclusion criteria: clear primary diagnosis of AN (restricting or purging subtype) based on the DSM-IV, confirmed by a psychiatric interview by an independent physician; illness duration ≥10 years; lack of response to ≥2 typical modes of treatment including one hospital admission or inpatient treatment in an eating disorder specialized clinic; substantial functional impairment according to the DSM-IV criterion C and Global Assessment of Function (GAF-score) ≤45 for ≥2 years; and BMI <15. Other in- and exclusion criteria are described previously (1). In addition, we recruited eight healthy control subjects from previous (neuroimaging) projects of our department and by advertisements. The control subjects were matched in age and gender, were right-handed and had to have a BMI between 18.5 and 25. The control subjects and their first-degree relatives had to have negative lifetime histories of psychiatric illness. Procedure Following our earlier DBS studies on OCD and MDD (24, 25), we distinguished four sequential study phases: preoperative (T-1), surgery (T0), optimization (3–9 months; T1-T2) and maintenance (12
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