67 Deep Brain Stimulation of the Ventral Anterior Limb of the Capsula Interna in Patients with Chronic Treatment-Refractory Anorexia Nervosa Figure 1. Time course of DBS-induced BMI (fixed effects ± SE). Linear mixed model analyses showed a significant linear effect of time on BMI (43.16±15.96, CI 95% 9.07-77.25, t=2.704, P=.017). The score on the YBC-EDS showed a significant improvement over time (-23.9%; P=.012). This effect was driven by significant decreases in the Preoccupation and Rituals subscales (-16.2%; P=.026, and -31.1%; P=.001, respectively). This corresponded with the secondary outcome EDE-Q, which showed significant improvements on the subscales Restraint and Eating Concern (P=.039 and P=.024, respectively). The HAM-D and HAM-A showed additional significant improvements (-36.7% and -47.9%, respectively). The ED-QOL showed a significant improvement over time on the subscale Physical Health (P=.005) (Supplement 2, results). Evidently, there are points of discussion. The mean baseline BMI of our patients was extremely low (categorized as ‘very severe’ in the DSM-5), which on average improved at one year postoperatively to the DSM-5 category ‘mild’. The increase in BMI was primarily seen in two of four patients. The other two subjects showed only a mild increase in BMI. This response rate of 50% is comparable to other studies (2, 3). Improvement was also observed in psychological outcomes. Two out of four patients were categorized as responders (≥35% decrease on the YBC-EDS). All patients reported a decrease in preoccupations and rituals, experiencing them as less rewarding. There was a decrease in eating-related behavior like purging and caloric and body checking, and significant decrease in depression and anxiety symptoms, which have great clinical importance for AN-patients (9). All patients reported a subjective improvement of their psychological state and quality of life. The majority of patients reported that eating disorder behavior and rituals have lost their rewarding properties, leaving the more room for healthier behavior. All patients confirmed that they still would prefer DBS, even though their eating disorder did not reach complete remission. 10 12 14 16 18 20 22 24 26 T-1 T0 T1 T2 T3 T4 BMI (KG/M2) PHASE BMI DBS-AN-001 DBS-AN-002 DBS-AN-003 DBS-AN-004 Mean
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