My guest is Casey Halpern, M.D., Chief of Stereotactic and Functional Neurosurgery and Professor of Neurosurgery at the Perelman School of Medicine at the University of Pennsylvania. Dr. Halpern’s research and clinical practice focus on using deep brain stimulation to treat compulsive and movement disorders (e.g., binge eating disorders, bulimia, obsessive-compulsive disorder (OCD) and Parkinson’s disease essential tremor, dystonia). We discuss using deep brain stimulation to help patients who suffer from movement and compulsive disorders and applying this treatment to patients afflicted with binge eating. We also explore applications of this technology to other conditions such as OCD, anorexia and tremor, and the future therapeutic directions of the use of non-invasive brain stimulation approaches, including transcranial magnetic stimulation and ultrasound, for the treatment of other psychiatric illnesses and conditions. This episode will interest those curious about the biology of eating, anorexia, bulimia, compulsive thoughts and behaviors, and movement. For the full show notes, visit hubermanlab.com. Thank you to our sponsors AG1 (Athletic Greens): https://athleticgreens.com/huberman LMNT: https://drinklmnt.com/huberman Thesis: https://takethesis.com/huberman Supplements from Momentous https://www.livemomentous.com/huberman Timestamps (00:00:00) Dr. Casey Halpern & Disordered Eating & Brain Stimulation (00:03:35) Sponsors: LMNT, Thesis, Momentous (00:08:28) Neurosurgeon’s View of the Brain, Neurosurgery Specialization (00:13:05) Deep Brain Stimulation & Other Unexpected Positive Effects (00:17:20) Obsessive Compulsive Disorder (OCD), Prescriptions & Cognitive Therapies (00:25:40) Brain Areas in OCD, Risk, Rewards & Addiction (00:29:30) Sponsor: AG1 (00:32:27) Facial and Vocal Ticks, Stimulants, Stress & Superstition (00:39:28) Nucleus Accumbens, Reward Circuits, Eating Disorders & Obesity (00:47:18) Stimulation of Nucleus Accumbens, Continuous vs. Episodic Stimulation (00:49:49) Binge Eating Disorder & Loss of Control Eating (00:53:02) Developing Binge Eating Disorder: Predisposition, Environment, Stress (01:02:07) Electrodes in Nucleus Accumbens, Identifying “Craving Cells” (01:11:41) Effects of Stimulation, Interrupting Craving, Intermediate Stimulation (01:16:46) Anorexia, Obesity & Compulsions, Potential Treatments for Anorexia (01:23:14) Non-Invasive Brain Stimulation, Transcranial Magnetic Stimulation (01:32:27) MRI-Guided Focused Ultrasound: Tremor, Essential Tremor & Parkinson’s (01:36:40) Future of Non-Invasive Brain Stimulation, Epilepsy & Depression (01:41:51) Pre-Behavioral States in Compulsion & Awareness, Mood Provocation (01:48:02) Machine Learning/Artificial Intelligence & Compulsion Predictions (01:53:05) Neurosurgeon Hands, Resistance Training & Deadlifts (01:59:00) “Neurosurgeon Calm,” Quality Time & Prioritization, Neurosurgeon Training (02:09:53) Daily Habits: Sleep, Exercise, Mediation (02:11:59) Zero-Cost Support, YouTube Feedback, Spotify & Apple Reviews, Sponsors, Momentous Supplements, Neural Network Newsletter, Instagram, Twitter, Facebook, LinkedIn Title Card Photo Credit: Mike Blabac Disclaimer
This podcast episode discusses the use of brain surgery techniques such as removing or stimulating parts of the brain, and deep brain stimulation, to treat eating disorders and movement disorders like Parkinson's disease and dystonias. It explains the role of stimulating the neuronal activity in nucleus accumbens to control loss of control eating, and shares insights about the latest advances in neuroscience.
Neurosurgeons do more than just operate on the brain. They also handle spine surgeries, treat herniated discs, and use deep brain stimulation to address psychiatric conditions related to movement disorders like Parkinson's disease.
Deep brain stimulation and capsulotomy are invasive surgical interventions for obsessive-compulsive disorder. Cognitive therapies and exposure response prevention are also effective for these patients.
The prefrontal and orbital frontal cortex are consistently implicated in patients with OCD when studying the disorder through imaging or invasive electrode techniques. These regions are involved with compulsive behaviors such as washing or cleaning that are characteristic of OCD.
The nucleus accumbens and cortical areas are main circuits involved in psychiatric disorders like OCD and can be related to addiction and reward. This podcast episode explores the link between stress, OCD, and reward circuitry and how it can manifest in food and eating-related disorders.
The repeated exposure to strong and rewarding stimuli such as high-fat foods or drugs of abuse can disrupt the normal functioning of the nucleus accumbens, leading to binge eating and loss of control eating. Penn is conducting deep brain stimulation trials to modulate the nucleus accumbens for patients who have failed gastric bypass surgery and might have binge eating or loss of control eating disorders.
In this episode, the host discusses the characteristics of binge eating disorder, the frequency of its occurrence, and its association with obesity. He further explores the potential causes of binge eating disorder, differentiating it from OCD and addiction.
A two-hit hypothesis is discussed to understand complicated surgical and clinical problems. One must consider both the predisposition and environmental stressors to study a complex problem in the operating room and clinic.
By placing an electrode in the nucleus accumbens, the brain's reward center, researchers can detect when cravings are happening and try to prevent overeating behavior. This technique is similar to treating Parkinson's disease patients for tremors by stimulating the brain's subthalamic nucleus.
Researchers are studying whether brief stimulation of the brain can disrupt the craving-to-binge cycle in individuals struggling with food or drug addiction. By identifying craving cells and delivering intermittent stimulation, they hope to alleviate feelings of anxiety or negative affect, disrupting the cycle and promoting a healthier lifestyle.
The nucleus accumbens may be a site that harbors cells responsible for craving and fasting states, leading to compulsive overeating or undereating, which are similar features in both anorexia and obesity phenotypes. Investigating this may help us understand more about how the brain works, as structures do not control functions entirely.
The use of non-invasive brain stimulation, ablation, and blockade of brain activity is becoming more common in the treatment of various brain syndromes, including depression. Neurosurgeons are developing less invasive methods for these treatments.
Different brain areas can be probed non-invasively with precision through brain stimulation experiments with patient volunteers, leading to a better understanding of preferred brain areas for stimulation.
Transcranial Magnetic Resonance Guided Focus Ultrasound may have potential beyond just ablation, with the ability to modulate neuronal activity and potentially help patients with essential tremor or deliver medication for brain tumors.
Researchers are focusing on pre-behavioral states of individuals for better mental health treatments, as they hope to prevent binge eating or drug use before they happen. Studies have been conducted in epileptic patients with electrodes to provoke depressed states and comorbid depression among the patients.
The speaker suggests that improving patient awareness around their mental health problems can be a powerful way to help patients. He argues that by using machine learning, we can help anticipate impulsive episodes and provide better mental health monitoring.
The host emphasizes the importance of staying connected with fellow neurosurgeons and friends in the field through technology. The guest gives insight into how the field of neurosurgery may select for individuals that can remain calm and handle fluctuations in real time.
Neurosurgeons are known for their calm demeanors which may be amplified by the gentler days of their research work. Their tough junior year in residency may contribute to weight gain.
In this podcast, Tim Ferriss interviews Dr. Casey Halpern about the use of deep brain stimulation and novel technologies for the treatment of eating disorders and movement disorders of various kinds. They discuss the latest understanding of how the human brain works and how it can be repaired using cutting-edge technology.