Why is a neuropsychiatric and tick-borne disease evaluation service needed?
Lyme Disease is the best known tick-borne disease, though several other infections are also caused by ticks and can cause similar symptoms. 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 conducted over a two-day interval. Each patient will get a 1.5 - 2 hour interview with Brian Fallon, MD, to review the symptom and treatment history and assess current status. This will be followed by a five- or six-hour battery of neuropsychological tests that will be divided over two 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. On the second day, each patient will have blood tests that have been chosen to target the patient's particular historical and current presentation. Blood tests for tick-borne diseases are sent to labs known to be particularly reliable and sensitive.
Some patients on the second day (or on another day) may also have brain MRI or SPECT imaging if it is needed to help clarify the diagnosis. Patients with primary neurologic presentations will also be referred to see adult neurologist Dr. Carolyn Britton or one of Columbia's excellent pediatric neurologists.
Approximately two weeks later, after the results have been gathered and analyzed, all patients will then have a telephone follow-up session with Dr. Fallon to review the results and recommendations from the evaluation.
What age patients are eligible?
At present, we are able to see individuals age thirteen and older. In the future, we hope to be able to accommodate younger children as well.
Staff
Brian Fallon, MD, Director
Kathy Corbera, MD, Associate Director
Treatment Team
The Neuropsychiatric and Tick Borne Disease Evaluation Service team includes Dr. Brian Fallon (Director), Dr. Kathy Corbera (Associate Director), and other individuals trained in neuropsychiatry, internal medicine, neuropsychology, and neurology. Collaborating with our Service are consultants in pediatric neurology, rheumatology, infectious disease, and radiology.
Financial Information
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/Referrals
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.
Location
New York Presbyterian Hospital
Columbia University Medical Center
635 West 165th Street
Eye Institute, 6th Floor
New York, New York 10032
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