Treatment, What Can I Expect?


Dr. Scopelliti Discusses The Cause And The Treatment Of Vertigo


Because of the advanced training involved in becoming a board certified functional neurologist, evaluation and management of brain based disorders is invariably different from what one may expect. On an initial visit, a complete and thorough history taking is routine. During this phase of the visit, the doctor will try to determine what may neurologically be causing your symptoms. Neurologic examination will be comprehensive, and can be vast and encompassing pending your condition. More complicated clinical cases can involve the use of somewhat unfamiliar yet non-invasive medical equipment, such as VNG infrared photography, (video nystagmography), CAPS dynamic posturography, pulse oximetry, etc.. Of course these diagnostic tools are only used out of necessity, never out of routine. Routine evaluation includes taking of vital signs, cardiac function, checking vision, hearing, reflexes, sensation, muscle strength and tone, coordination, gait and stance, and much, much more. You may be scheduled for advanced procedures, which may or may not be provided by the doctor. Only after the doctor is confident in a diagnosis and treatment plan specific to your condition will treatment ever be provided. As most patients recover quickly from this approach, the doctor can quickly tell if you are getting better or not, thus lengthy courses of inappropriate treatment are avoided. Failure to accurately diagnose the cause of your vertigo symptoms, dizziness, disequilibrium, imbalance, etc., is the most common reason other therapy programs have failed. Because accurate diagnosis is integral to improvement, we typically see great improvement in little time, thus return care is minimal.


What’s The Next Step?


Our office uses simple but technologically advanced testing, (see Our Vestibular Laboratory), in aiding the evaluation and management of patients with imbalance vertigo symptoms, dizziness, ADD ADHD as well as other brain based disorders, many of which are discussed on this website.


We will always first obtain a necessary medical history from you. A complete neurologic and physical examination is always the next step, as discussed above.


Then we may do a series of simple, non-invasive balance tests, using the sensitive CAPS™ force platform and additional special software. (See Our Vestibular Laboratory). We will also look for signs of nystagmus, a rapid, jerky movement of the eyes that often indicates the presence of vertigo symptoms and dizziness, typically is associated with imbalance, and is also often associated with many neurologic disorders.


Then What?

After all those steps have been completed, we will review the results to determine if your problem originates in your vestibular system, (as many vertigo symptom, dizziness and imbalance problems do), your central nervous system, or somewhere else in your body.

If we conclude that you would benefit from the type of specialized functional neurologic rehabilitation type treatment that we are trained to provide, those treatments may then be scheduled.

If we feel it is necessary, you may be scheduled for advanced testing, or, infrequently, be referred to a different medical specialist for further evaluation and/or additional testing. This however, is very unlikely as unfortunately, many refer to us after having been everywhere else, rather then prior to, and for most, this meant years of unnecessary suffering.


If I Need Treatment, What Will Be Involved, And How Long Will It Take?

The functional neurologic rehabilitation type treatments that we provide usually involve only some simple, but very specialized exercises. Typically, this includes vestibular rehabilitation therapy exercises. Once you are trained in performing them on your own, many can be performed in the privacy of your own home without the need for repeat office visits. This reduces the need as well as the cost of treatment.

During the course of your treatment, you will be tested with the CAPS™ several times. This way, the results of your treatment will be immediately measured and documented. Most patient’s CAPS™ scores are higher after having only one treatment. Others require multiple treatments and multiple CAPS™ testing before they achieve optimum results.

Most of our imbalance patients experience an immediate improvement in their balance following treatment. In fact, many experience a dramatic improvement.

In a small percentage of cases, a treatment may actually make your balance temporarily worse, but when that happens we will know it immediately, so we will not waste time performing inappropriate treatment over long periods, only to find you worsening. We know it is wrong for you immediately! Because your CAPS™ score will instantly reflect a change, we will modify the treatment and test you again.

As mentioned before, after treatment most of our patients experience great improvements not only in their balance, but more importantly, in their overall quality of life!


How Much Is All Of This Going To Cost?

As your insurance company is a business, with their prime goal being profit, the reality of them paying your medical bills is becoming less of a reality and more wishful thinking. At least this is our repeated finding. As such, we prefer to not involve ourselves with in network policies, with the exception of a few, those which are not a battle to get reimbursement for our services. Managed care utilizes a middleman that makes the final determination on what you need without ever seeing you, and it has been our repeated finding that our services are never deemed to be required. This means sacrificing appropriate evaluation and treatment in favor of that which quite simply, won’t work but will be covered. Our ability to successfully treat you is completely determined by our being able to accurately diagnose you. We have developed a reputation, one which we have earned by getting many people better quickly, and we have done this by providing appropriate care at the highest level. As such we opt to remain out of network so that we may continue to do this. But don’t despair. We continue to offer more than reasonable fees in light of the many services which we offer. The cost of not getting better, being out of work, traveling to provider after provider, none of whom can help you, is actually far more significant a cost than our fee to get better. We anticipate that you will call or email Debbie to discuss any questions or concerns which you may have before deciding on a complete examination or any treatment. We will also verify your insurance benefits if you have them and discuss any fee related questions at this time. You will need to discuss this with our office manager Debbie prior to scheduling, as we book an hour to an hour and a half for an examination.

Dr. Scopelliti is a Functional Neurologist in Monmouth County NJ.