Patients in tick-infested areas throughout the United States, but particularly in the Northeast, mid-Atlantic, upper Mid-west, and Pacific coastal states, are often faced with not knowing whether their neuropsychiatric symptoms may be independent and unrelated to an underlying medical problem or dependent and secondary to an underlying medical condition, as might be seen with a:
- tick borne infection (Borrelia burgdorferi, Babesia microti, or Bartonella henselae);
- nutritional deficiency (Vitamin B12);
- endocrine imbalance (thyroid, hypothyroid); or an
- immunologic problem (Systemic Lupus).
The goal of this Service is to help patients clarify their diagnosis and treatment planning.
What neuropsychiatric symptoms may be induced by medical problems?
Common neuropsychiatric symptoms induced by medical problems include problems with cognition; mood, anxiety or psychotic disorders that do not respond to standard therapies; sensory hyperarousal syndromes (light, sound, smell, vibration); disrupted sleep; and unrelenting chronic fatigue. Accompanying these neuropsychiatric disorders may be other symptoms/signs that would suggest an underlying medical diagnosis, such as balance or gait problems; peripheral neuropathies; night sweats; fevers; radicular pains; headaches; arthralgias or myalgias; or atypical dermatologic lesions.
How long does the evaluation take and what is done?
The evaluation is typically conducted over a two-day interval. Each patient is evaluated by a physician to review the symptom and treatment history and to assess current status. This is accompanied by a 5-6 hour battery of neurocognitive tests and self-report assessments that are divided most often over 2 days. These assess multiple domains of cognition, including memory, verbal fluency, general intelligence, motor and psychomotor processing speed, working memory, attention/concentration, and executive functioning. Most often, the evaluating physician orders blood tests that have been chosen to clarify the diagnosis and differential diagnosis. Because patients come to us for a second opinion regarding complex multi-systemic problems, additional blood work is often extremely helpful in ruling out other possible diagnostic causes and in clarifying the tick-borne disease diagnosis. Blood tests for tick-borne diseases are sent to labs known to be particularly reliable and sensitive. If the patient undergoing evaluation does not want additional blood tests or if his/her insurance carrier will not cover the cost of the blood tests, then the patient should make this information clear to the physician during the evaluation. Should other tests be helpful, such as an MRI or SPECT or lumbar puncture, these will be recommended by the evaluating physician to be ordered by the patient's physician in his/her town. While recommendations for treatment options are made, the Evaluation Service itself does not provide treatment.
After the evaluation at Columbia University Medical Center, the results of the neurocognitive tests will be scored and a report will be generated. The physician will also generate a report that will be sent to the patient with impressions and recommendations. Patients with questions about the report are encouraged to contact the evaluating physician for further discussion.
What age patients are eligible?
At present, we are able to see individuals age 18 and older.
The Neuropsychiatric and Tick Borne Disease Evaluation team consists of doctors with a particular interest and expertise in evaluating complex symptom presentations in patients with a history of Tick-borne disorders. Individuals on our team are trained in various disciplines of relevance to patients with neuropsychiatric problems and Tick-borne diseases, including neuropsychiatry, internal medicine, neuropsychology, and neurology. Members of our team who may be involved in an individual's evaluation include Dr. Brian Fallon, Dr. Kathy Corbera, Dr. Carolyn Britton, Dr. Sonya Martin, Dr. Michael Daras, and Dr. John Keilp.
Payment in full is required prior to evaluation. ATM/Debit/Credit cards are accepted. Patients will be given an itemized bill which they can then submit to their insurance carrier for possible reimbursement.
Appointments should be made in advance directly by the patient by calling Dr. Kathy Corbera at 212-543-6508. Walk-in appointments are not accepted.
Columbia University Medical Center
710 West 168th Street, 12th Floor
New York, New York 10032