Functional neurological symptoms

PAEDIATRIC

  • If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or follow local emergency care protocols or seek emergent medical advice if in a remote region.

    Functional neurological symptoms

    • The patient is unable to mobilize safely or has frequent falls/seizure like attacksAddition
    • Refer to HealthPathways or local care pathway
    • A functional neurological disorder (FND) is a condition in which patients experience neurological symptoms such as weakness, sensory symptoms (e.g. pain sensitivity/numbness, sound distortion, visual changes etc), abnormal movements (sometimes seizure-like, 'non-epileptic seizures') or loss of awareness / dissociation). The brain of a patient with functional neurological symptom disorder is structurally normal, but functions incorrectly at times, with capacity to return to normal function. A diagnosis of a co-morbid psychological/psychiatric disorder is not required in this condition.  This disorder is considered due to 'software glitches' in automatic brain networks, not under direct control of the patient. Symptoms of functional neurological disorders are clinically recognisable but are not categorically associated with a definable organic disease. FND is a clinical diagnosis based on history and examination. Physical examination can demonstrate positive confirmatory findings of FND. If the clinical presentation is consistent, investigations for other conditions are not necessary.
    • In the majority of cases it is thought inappropriate for children to wait more than 6 months for an outpatient initial appointment
    • Referral from a health practitioner other than a General Paediatrician may be accepted if there is limited access to public Paediatric services in the patients' local area
    • A change in patient circumstance (such as condition deteriorating) may affect the urgency categorisation and should be communicated as soon as possible.
    •  
    • Clinical urgency is the dominant consideration in the prioritisation of a referral for a child currently in out of home care (OOHC), or at risk of entering or leaving OOHC

    Clinical resources

    Patient resources

Minimum Referral Criteria
Category 1
(appointment within 30 calendar days)
  • Unable to attend school or other significant disability due to symptoms
  • High levels of health anxiety (e.g. patient's condition mimics stroke/epilepsy/neuropathy)
  • A child currently in out of home care (OOHC), or at risk of entering or leaving OOHC, where they have previously been on a waiting list for this problem and were removed without receiving a service.
Category 2
(appointment within 90 calendar days)
  • Patients with FNS without the level of disability required for cat 1, referred by a General Paediatrician
  • Request for second opinion for diagnosis
Category 3
(appointment within 365 calendar days)
  • No category 3 criteria

Please insert the below information and minimum referral criteria into referral

1. Reason for request Indicate on the referral

  • To establish a diagnosis
  • For treatment or intervention
  • For advice and management
  • For specialist to take over management
  • Reassurance for GP/second opinion
  • For a specified test/investigation the GP can't order, or the patient can't afford or access
  • Reassurance for the patient/family
  • For other reason (e.g. rapidly accelerating disease progression)
  • Clinical judgement indicates a referral for specialist review is necessary

2. Essential referral information Referral will be returned without this

  • Description of symptom(s) including date of onset, nature of the symptoms, duration and frequency (eyewitness history where possible)
  • Burden of disease information:
    • is the child missing school? How many days missed in the last month?
  • Confirmation of OOHC (where appropriate)

3. Additional referral information Useful for processing the referral

Highly desirable Information – may change triage category

  • Note if there are triggers or associations with the events or not. For example, pain, frustration, exercise, feeding, sleep.
  • If the child is in foster care, please provide the name and regional office for the Child Safety Officer who is the responsible case manager.

    Desirable information- will assist at consultation

  • Any allied health assessments
  • Other past medical history
  • Immunisation history
  • Developmental history
  • Medication history
  • Significant psychosocial risk factors (especially parents mental health, family violence, housing and financial stress, department of child safety involvement)
  • Examination findings inclusive of CNS, birth marks or dysmorphology

    Investigation results:

  • ECG, EEG and neuroimaging if available. (Do not order these tests for the referral if they are not clinically required)
  • If neuroimaging has been done, arrange image transfer to PACS at the hospital the patient is being referred to, with the imaging reports. If electronic imaging transfer is not available, then a CD of the neuroimaging and report should be sent to the neurologist named in the referral.

4. Request

  • Patient's Demographic Details

    • Full name (including aliases)
    • Date of birth
    • Residential and postal address
    • Telephone contact number/s – home, mobile and alternative
    • Medicare number (where eligible)
    • Name of the parent or caregiver (if appropriate)
    • Preferred language and interpreter requirements
    • Identifies as Aboriginal and/or Torres Strait Islander

    Referring Practitioner Details

    • Full name
    • Full address
    • Contact details – telephone, fax, email
    • Provider number
    • Date of referral
    • Signature

    Relevant clinical information about the condition

    • Presenting symptoms (evolution and duration)
    • Physical findings
    • Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
    • Body mass index (BMI)
    • Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
    • Current medications and dosages
    • Drug allergies
    • Alcohol, tobacco and other drugs use

    Reason for request

    • To establish a diagnosis
    • For treatment or intervention
    • For advice and management
    • For specialist to take over management
    • Reassurance for GP/second opinion
    • For a specified test/investigation the GP can't order, or the patient can't afford or access
    • Reassurance for the patient/family
    • For other reason (e.g. rapidly accelerating disease progression)
    • Clinical judgement indicates a referral for specialist review is necessary

    Clinical modifiers

    • Impact on employment
    • Impact on education
    • Impact on home
    • Impact on activities of daily living
    • Impact on ability to care for others
    • Impact on personal frailty or safety
    • Identifies as Aboriginal and/or Torres Strait Islander

    Other relevant information

    • Willingness to have surgery (where surgery is a likely intervention)
    • Choice to be treated as a public or private patient
    • Compensable status (e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.)

  • If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or follow local emergency care protocols or seek emergent medical advice if in a remote region.

    • Please note that where appropriate and where available, the referral may be streamed to an associated public allied health and/or nursing service.  Access to some specific services may include initial assessment and management by associated public allied health and/or nursing, which may either facilitate or negate the need to see the public medical specialist.

    • A change in patient circumstance (such as condition deteriorating, or becoming pregnant) may affect the urgency categorisation and should be communicated as soon as possible.

    • Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally.

Last updated: 20 December 2021

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