Dr. Casey Halpern

The problem I think comes down to the fact that some of these patients are so resistant to treatment.

And the patients that we see as a surgeon, for example,

are the patients that they've tried cognitive behavioral therapy, certainly have tried medications, they've tried behavioral management.

They're as aware as they could possibly be, and they still lose control.

We've had this studied in the lab.

So we will bring patients to the laboratory with this implanted device to try to provoke this electrographic electrical signal that can be detected by the actual device that will stimulate them when they're at home.

But before we actually initiate stimulation, we want to see, can this device detect this craving cell signal, which is going to be different than what we saw in the operating room because that's a single cell.

But these devices, these electrodes are about a millimeter in diameter instead of like a tenth of a millimeter, which is what we use in the operating room.

So they're only hearing or detecting, I should say, thousands of cells' responses.

And

we actually have a way to provoke binges.

It's called a mood provocation.

It's very well validated.

It's a little bit like provoking seizures in the epilepsy monitoring unit, but here in the sort of psychiatric monitoring unit or the food monitoring unit, we actually have a psychiatrist and eating disorder specialist come

induce a mood that is related to each patient's sort of self described binge episode.

That's exactly right.

So that we can video and synchronize the video to the brain signal recordings.

The patients all wear an eye tracker so we can see what they're eating at all times and what they're looking at specifically.

And that allows us to have the best temporal resolution possible to understand what is happening right before the bite.

And even under video surveillance through a one-way mirror in a laboratory setting, when patients are very well aware that they're there to be studied if they're going to binge, they still do.