Seizures/epilepsy

ADULT

  • 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.

    Adult

    Stroke/transient ischaemic attack (TIA)

    • Patient with acute neurological symptoms of a stroke; multiple/crescendo TIA
    • New acute symptoms

    Progressive loss of neurological function

    • Acute onset severe:
      • ataxia
      • vertigo
      • visual loss
    • Acute severe exacerbation of known MS

    Seizures/epilepsy

    • Status epilepticus/epilepsy with concerning features:
      • first seizure
      • focal deficit post-ictally
      • seizure associated with recent trauma
      • persistent severe headache > 1 hour post-ictally
      • seizure with fever

    Headache/migraine

    • Headache with concerning features:
      • sudden onset/thunderclap headache
      • severe headache with signs of systemic illness (fever, neck stiffness, vomiting, confusion, drowsiness)
      • first severe headache age > 50 years
      • severe headache associated with recent head trauma
      • recent onset headaches in young obese females
      • headaches with papilledema
      • >50 years with raised CRP/ESR or if giant cell arteritis or vasculitis suspected

    Movement disorders

    • Ocular

    Other referrals to emergency

    • Altered level of consciousness
    • Bilateral limb weakness with or without bladder and/or bowel dysfunction
    • Acute rapidly progressive weakness (Guillain-Barre Syndrome, myelopathy)
    • Delirium/sudden onset confusion with or without fever

    Paediatric

    Seizures/epilepsy

    • New onset seizures that require emergency care/advice
    • Status epilepticus (convulsive or non-convulsive)
    • Developmental/cognitive/psychiatric regression accompanying new onset or ongoing epileptic seizures
    • New onset seizure with new neurological deficit (e.g. focal weakness, speech impairment, cognitive impairment) – call 000 for emergency assessment for stroke and transport to the Emergency Department
    • Specific seizure types with epileptic encephalopathy risk e.g. infant with possible epileptic spasms
    • High initial seizure burden (>5 seizures, before first AED), excluding typical absence seizures
    • Neonate / infant (<12-month-old) with epileptic seizure onset

    Headaches/migraine

    • Headache with papilledema or change in vision/double vision (excluding established migraine with visual aura) or new neurological examination findings (e.g. sixth nerve palsy, gait disturbance, focal weakness)
    • Headaches that wake at night or headaches immediately on wakening
    • New severe headaches
    • Sudden onset headache reaching maximum intensity within 5 minutes (= explosive onset)
    • Focal neurological features
    • Associated with significant persisting change of personality or cognitive ability or deterioration in school performance

    Functional neurological symptoms

    • The patient is unable to mobilize safely or has frequent falls/seizure like attacksAddition

    Movement disorder

    • Abrupt onset or deterioration of a movement disorder
    • Acute onset of ataxia / chorea
    • Impairment of function i.e. walking, attend school

    Hypotonic infant

    • Tachypnoea (signs of respiratory distress such as accessory muscle use are NOT seen in patients with neuromuscular disorders)
    • Feeding difficulties with weight loss

    Gait abnormality, isolated motor delay or focal weakness

    • Acute onset of (or rapidly progressive) weakness e.g. Guillain Barre syndrome, transverse myelitis
    • Acute onset focal weakness (suspected stroke – call 000)
    • Breathing difficulties (NB tachypnoea may be the only sign of respiratory distress in a child with a neuromuscular condition)
    • Feeding or swallowing difficulties
    • Acute foot drop or acute onset focal neuropathy

    Stroke

    • Acute stroke – call 000 and request urgent transfer (timelines apply for t-PA and thrombectomy for embolic/thrombotic stroke)

    Other neurological conditions

    • Developmental/ intellectual impairment or behavioural / psychiatric disorders with regression
    • Acute encephalopathy, acute confusional state, altered level of consciousness

    • Refer to HealthPathways or local guidelines
    • Ensure compliance, consider drug levels if non-compliance is suspected
    • Optimise current drug therapy/consider increasing dose if already on medication
    • Exclude drug interactions e.g. concurrent cytochrome inducers, binding agents
    • Reconsider diagnosis if no response to medication
    • Treat any inter-current infections and co-morbidities
    • Address any lifestyle issues e.g. adequate sleep, stress, alcohol, recreational drugs
    • Adequate chronic disease/lifestyle (SNAP) management is a requirement for most surgical procedures
Minimum Referral Criteria
Category 1
(appointment within 30 calendar days)
  • New diagnosis of epilepsy (confirmed or highly likely) without a review by neurologist
  • First epileptic seizure (as convulsive syncope is a common mimic, may be seen by general medicine prior to neurology, depending on local pathways)
  • Frequent epileptic seizure activity without current use of antiseizure medications
  • Documented increased frequency of Generalised tonic-clonic or bilateral tonic clonic seizures in patient with good adherence to medical treatment
  • Pregnancy in a patient with known epilepsy
Category 2
(appointment within 90 calendar days)
  • Poorly controlled epilepsy (e.g. increased frequency of seizures, change in seizure activity) in patient with good adherence to medical treatment. (This may be categorised as Cat 1 depending on severity)
  • Psychogenic non-epileptic seizures (PNES) /Suspected dissociative attacks* seeking clarification of diagnosis

*Suspected dissociative seizures should be triaged according to the social and medical impact of their epileptic-seizure counterparts rather than based on the (suspected) cause
Category 3
(appointment within 365 calendar days)

  • Chronic epilepsy without any concerning features.  
  • Epilepsy advice and management plan including driving recommendations and decreasing anti-epileptic medication

Concerning features include:

  • persistent focal deficit post-ictally
  • seizure associated with recent trauma
  • persistent severe headache > 1 hour post-ictally
  • seizure with fever

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

  • History of seizures
  • Medication history, including non-prescription medications, herbs and supplements
  • Management history of epilepsy (including previous medication, dosage, efficacy, side effects)

3. Additional referral information Useful for processing the referral

  • ELFT, FBC
  • EEG results
  • Neuroimaging results
  • Family history
  • Drug and alcohol history
  • Sleep studies
  • HIV syphilis

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: 5 June 2024

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