13 General Introduction size (n=4) of patients suffering from exceptionally severe AN. The severity of both the disorder and the medical conditions of these patients has made the study’s execution highly challenging. Nevertheless, these participants represent the prototypical patients who may qualify for DBS as a last-resort treatment option. We note that the results were published as a letter-to-the-editor in Brain Stimulation in December 2021, and in this thesis, we will incorporate the full manuscript along with supplementary material. During the final few years, a few other groundbreaking studies on DBS in AN, as well as several case reports, have been published. Consequently, we will present the first meta-analysis assessing the efficacy and safety of DBS in AN treatment. This analysis encompasses four studies, including our own. We will describe the outcomes of this meta-analysis in the fourth chapter of this thesis. Part IV – Deep brain stimulation in anorexia nervosa: functional effects Part IV of this thesis will present the results of our sub-studies focusing on the functional effects of Deep Brain Stimulation (DBS) in Anorexia Nervosa (AN). In Chapter 5, we will disclose the findings from our task-based fMRI study, which utilized a monetary reward task and a food picture viewing task. Our objective is to enhance the understanding of both the operational mechanisms of DBS and the pathophysiological mechanisms underlying AN. Chapter 6 will detail our investigation into the time-dependent electrophysiological changes induced by DBS in patients with AN. Our aim here is to contribute to a more comprehensive understanding of the electrophysiological effects of DBS. Such insights may enable us to personalize and optimize the intervention, thereby increasing its effectiveness in treating AN. Lastly, in Chapter 7, which is the final chapter devoted to the functional effects of DBS in AN, we will explore endocrine and metabolic alterations post-DBS, with a particular emphasis on neuroendocrine parameters that influence food reward and satiety. We will conduct repeated endocrine and metabolic measurements during the follow-up period. Our hypothesis will suggest that these parameters, which are associated with AN, will undergo changes over time due to DBS treatment and/or weight gain in the course of the DBS intervention. Part V - Anorexia nervosa: conceptual hypotheses During the course of our study, we have intensively monitored the clinical status of the subjects. As stated before, executing the study posed several challenges, which we will elaborate on in the discussion section of this thesis. One observation stood out markedly: clinically, subjects reported a subjective decrease in the rewarding properties of their eating-disorder related behaviors. Concurrently, we observed an increase in self-destructive behavior in our subjects. This lead to questions about the link between AN and self-destructive behavior: whether they share a
RkJQdWJsaXNoZXIy MjY0ODMw