190 Summary and discussion by the Yale-Brown-Cornell Eating Disorder Scale (YBC-EDS), indicated a general enhancement relative to baseline measurements. Half of the patient cohort could be classified as responders, registering a symptom reduction of 35% or greater. Importantly, all participants noted a decline in eating-disorder related obsessions and compulsions, finding them less gratifying - an observation consistent with the Lipsman et al. (2017) study (3). Additional survey instruments corroborated these clinical improvements, signaling a considerable reduction in average symptoms of depression and anxiety - a crucial outcome given the high prevalence of comorbidities in AN. Within the domain of Quality of Life (QoL), our study revealed ameliorations in the ED-QOL (physical health), MOS-SF-36 (physical function), and SDS (responsibilities) subscales. Nevertheless, other QoL subscales did not show a parallel enhancement, thereby underlining the enduring psychopathological struggles associated with AN and its comorbid conditions among this severely and chronically afflicted patient population. Notwithstanding these challenges, clinical outcome data indicated enhanced quality of life, and despite the persistence of severe pathology, no patients sought the deactivation or removal of the DBS device. In summation, the data presented herein substantiate the assertion that vALIC DBS offers a promising, albeit investigational, avenue for the treatment of chronic, treatment-resistant AN. Despite the limitations of this small-scale pilot it serves as an invaluable preliminary investigation into the efficacy, major challenges, safety considerations, and feasibility parameters associated with this emerging treatment modality. In Chapter 4, we present the first meta-analysis focused on the utilization of deep brain stimulation (DBS) in the treatment of anorexia nervosa (AN). Utilizing a random-effects model, the meta-analysis (4 studies with a total of 56 patients) revealed a statistically significant improvement in the primary outcome of BMI, registering a large effect size of 1.13. Notably, this result was accompanied by an absence of observed heterogeneity. Furthermore, the study delineated a favorable influence on comprehensive psychiatric symptom severity, achieving a similarly robust effect size of 0.89. Across four symptom domains - namely, depressive symptoms, obsessive-compulsive symptoms, symptoms of anxiety, and eating disorder symptoms - and in QoL the meta-analysis observed large effect sizes. Collectively, these findings suggest that DBS exerts statistically significant and large-scale beneficial effects severe, treatment-resistant AN. The observed outcomes are congruent with the documented efficacy of DBS in the management of other psychiatric disorders, such as depression and OCD. Moreover, the clinical efficacy of DBS, as elucidated by this meta-analysis, may yield valuable insights into the pathophysiology underlying AN. The studies incorporated into the meta-analysis
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