148 Chapter 7 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. Procedure We conducted bilateral stereotactic implantation of DBS electrodes in the anterior limb of the internal capsule (vALIC). Following our earlier DBS studies, we distinguished four sequential phases: preoperative (T-1), surgery (T0), optimization (3–9 months; T1-T2) and maintenance (12 months; T2-T4). After screening at T-1, bilateral DBS electrodes were implanted in the vALIC at T0. We turned on and optimized DBS settings from T1 to T2, and followed patients up to T4. During the study patients received standard medical and psychiatric care, comprised of regular visits with a nurse-practitioner and a psychiatrist. No major psychopharmacological adjustments were made. For an extended overview of the methods see Oudijn e.a. 2021 (5). Data acquisition and analysis We took fasting blood and urine samples for laboratory analysis at T-1, T1, T2 and T4 (see figure 1). All samples were taken at the same time of day (9 a.m.). As one subject was postmenopausal, and the other three where amenorrhoeic, the phase of the menstrual cycle at the time of blood collection was not known. Samples were analysed by the Central Diagnostic Laboratory (CDL), the Laboratory for Endocrinology (ENDO), the Laboratory of Genetic Metabolic diseases (GMZ) in the Amsterdam UMC, location AMC, Amsterdam and by the Radboud Medical Center (Nijmegen). Supplement 1 shows type of tests and samples used, detection limits, reference ranges, and the inter-assay coefficients of variation. Figure 1. The temporal phases of the DBS treatment with the timepoints of laboratory analyses at T-1, T1, T2, and T4. Statistical analysis Statistical analyses were performed using Statistical Package for the Social Sciences (SPSS), version 26. Due to low sample size (n=4) we did not conduct tests for normality of the data. For
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