53 Deep Brain Stimulation of the Ventral Anterior Limb of the Capsula Interna in Patients with Chronic Treatment-Refractory Anorexia Nervosa Table 1. Patient’s Demographics. Sex Age at onset (years) Age at surgery (years) Illness duration (years) Anorexia Subtype BMI (screening) BMI (Historic low) Psychiatric comorbidities Psychiatric medication at surgery Patient 1 f 15 32 18 Purging 12.4 9.5 GAD, Depression, Personality Disorder NOS Aripiprazole, Quetiapine, Oxazepam Patient 2 f 15 39 24 Purging 11.2 10.2 SUD*, Personality Disorder NOS Aripiprazole, Quetiapine, Oxazepam Patient 3 f 14 33 19 Purging** 13.4 10.6 Depression, OCD, BPD Venlafaxine, Clorazepate, Oxazepam, Temazepam Patient 4 f 27 53 24 Purging 13.1 9.7 Personality Disorder NOS Citalopram, Alprazolam, Zolpidem Mean (SD) 18 (6) 39 (10) 21 (3) 12.5 (1.0) 10.0 (0.5) (BMI= Body Mass Index, f= female, GAD= Generalized Anxiety Disorder, OCD=Obsessive-CompulsiveDisorder, NOS= Not Otherwise Specified, SUD= Substance use disorder and BPD=Borderline Personality disorder) *The substance in question was alcohol, at the screening this was in remission. ** Important to note that for purging this patient used ± 50 Bisacodyl. DBS-settings Monopolar DBS at the middle two contacts was switched on at T1 (pulse width 90 μs, frequency 130 ms) at a mean voltage of 3,0 V (2,5-3,5 V). The mean voltages at T2, T3 and T4 were respectively 3,8 V (3,0-5,0 V), 3,8 V (3,0-4,5 V) and 3,8 V (2,7-4,8 V). Pulse width and frequency remained unchanged during the study. Clinical Outcomes (table 2) Physical: The primary physical outcome BMI showed a substantial and significant increase at the end of follow-up (5.32 kg/m2; +42.8%; P=.017) (figure 2). This effect was supported by significant linear improvements over time in the vital parameters systolic blood pressure (SBP), diastolic blood pressure (DBP) and body temperature (T) (P=.005, P=.007 and P=.018, respectively). At the end of follow-up, SBP, DBP and T showed a 27.75 mmHg (26.6%), 20.16 mmHg (31.0%) and 1.12 °C (3.3%) increase compared to T-1, respectively. Two patients reached a BMI in the normal range, two remained in the underweight BMI range.
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