156 Chapter 7 observed alterations, but do not negate their interest. It is difficult to extrapolate our finding to either AN or DBS. Finally we did not find any changes within fatty acid levels. Brain lipid peroxidation is not able to be directly assessed in living subjects. The calculated peroxidation index can approximate lipid peroxidation, however more direct measures of lipid peroxidation are needed to determine lipid peroxidation in the brain more specifically (29). Nevertheless, this is a first investigation of major endocrine and metabolic parameters to establish possible changes over time during DBS treatment. Data - including strong changes over time - provide new insights in DBS working mechanisms and AN pathophysiology. Conclusion In this first pilot study on the endocrine and metabolic effects of DBS in AN we hypothesized that endocrine and metabolic parameters associated with AN would show changes over time with DBS treatment and associated weight gain. We found a significant decrease in testosterone (21.47%) and cortisol (47.39%) levels over time. Furthermore, we found decreases in progesterone, ACTH, GH, adiponectin, ADH, adrenalin and noradrenalin levels, and increases in T3, IGF-1, and leptin, although not significant, possibly due to the small sample size and the high variability of individual levels. However, some of the results we found, like the significant decrease of plasma cortisol over time, suggesting an attenuation of the hypercortisolaemia, and the non-significant increase in leptin in the subjects that responded to DBS with weight gain, suggest an effect of DBS or DBS-modulated weight changes on endocrine and metabolic parameters. These findings stimulate further research on the complex interaction between physiology, disordered eating and neuromodulation. Future perspectives Larger studies on the effects of DBS on endocrine and metabolic parameters in AN are needed. It would also be interesting to conduct measurements in DBS-ON and DBS-OFF state to study the direct influences of DBS on the endocrine and metabolic system.
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