12 Part I DEEP BRAIN STIMULATION IN ANOREXIA NERVOSA Clinically, there are many similarities between OCD and AN. AN is characterized by obsessions and compulsions regarding body image, weight, food intake and energy expenditure. Furthermore, there are substantial rates of comorbidity between AN and OCD. There is also considerable pathophysiological overlap between AN and OCD. Both conditions have been associated with dysfunction in the cortico-striato-thalamo-cortical circuitry (also known as the aforementioned reward circuitry), altered dopamine signaling, and altered reward processing (10). Therefore, we hypothesized that targeting the vALIC may exert comparable beneficial effects in treatment-refractory AN. Moreover, our DBS methodology has distinctive characteristics, including an extensive optimization period during which DBS-settings are optimized with thorough phenotyping. This may provide new insight in the psychological, somatic and functional effects of (vALIC) DBS in AN. We thus developed the first research protocol in The Netherlands to study the efficacy, safety and tolerability of DBS in patients with severe, chronic, treatment-refractory AN. SCOPE AND OUTLINE OF THIS THESIS Part I – Introduction Part II - Deep brain stimulation in anorexia nervosa: hypothesis-formation In the second part of this thesis, we will outline the formation of our hypothesis, stating that deep brain stimulation (DBS) will serve as an effective treatment for patients suffering from chronic, treatment-refractory Anorexia Nervosa (AN). We will argue that DBS will not only facilitate weight restoration but will also yield significant and sustained improvements in the core symptoms of AN, along with associated comorbidities and complications. Additionally, we will propose potential targets within the brain that could be most effective for DBS application in treating AN. Moreover, inspired by a case study that reported smoking cessation and substantial weight loss following DBS treatment for Obsessive-Compulsive Disorder (OCD) in an obese patient, we will investigate the impact of DBS on body weight across a larger cohort of patients diagnosed with obsessive-compulsive disorder and depression. Part III – Deep brain stimulation in anorexia nervosa: clinical effects In the third part of this thesis, we will present the primary findings of our pilot study, titled ‘Deep Brain Stimulation of the Ventral Anterior Limb of the Capsula Interna in Patients with Treatment-Refractory Anorexia Nervosa.’ For this challenging study, we have included a small sample
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