11 General Introduction of effective, accessible treatments make it a critical issue in both medical and mental health settings. Investigating novel, effective treatment options for AN is crucial. The life of AN patients is literally on a scale. AN has multifactorial origins that include psychological, biological, and environmental factors. While the complete pathophysiology is not yet fully understood, a variety of mechanisms have been proposed to explain its development and persistence. The neurobiology of AN is a complex and still-emerging field of study. A variety of factors, including genetics, neurotransmitter activity, brain structure and function, as well as environmental influences, contribute to the onset and persistence of the disorder (5). Studies on the neurobiology of AN show that the brain reward system in particular, largely mediated by the neurotransmitter dopamine and implicated in motivation, pleasure and reinforcement learning, is involved in the pathophysiology of AN (6). In the search for novel, effective treatment options for AN, treatment modalities that could influence the neurobiological mechanisms involved in AN, and specifically the dysfunctionality of the reward system are of special interest. DEEP BRAIN STIMULATION Deep brain stimulation (DBS) is an integrative treatment that involves the implantation of electrodes into specific brain regions to modulate neural activity. While initially developed and approved for the treatment of movement disorders such as Parkinson’s disease, the application of DBS for psychiatric disorders has become an area of active research and clinical interest. DBS involves the placement of thin, electrode-tipped wires into brain regions identified as focal points for pathological neural activity. These electrodes are connected to a pulse generator, typically implanted in the chest, which delivers electrical pulses to the target brain regions. Among psychiatric disorders, the most robust evidence for the effectiveness of DBS exists for severe, treatment-resistant OCD. Multiple clinical trials have demonstrated significant symptom reduction and improvement of quality of life (7). In psychiatric disorders like OCD DBS is effectively targeted at the brain reward system. The mechanism through which DBS works is complex and not entirely understood, but it is thought to modulate the activity of neural circuits, effectively overriding pathological network activity allowing for reinstating psychological activity to alleviate symptoms (8). The 20-year experience of the departments of psychiatry and neurosurgery of the Amsterdam UMC, location AMC, with DBS in OCD-patients showed strong and long-lasting effects of targeting the ventral anterior limb of internal capsule (vALIC), part of the reward-circuitry (9).
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