Seizures/epilepsy
ADULT
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Emergency
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
Headaches/migraine
Functional neurological symptoms
- The patient is unable to mobilize safely or has frequent falls/seizure like attacksAddition
Movement disorder
Hypotonic infant
Gait abnormality, isolated motor delay or focal weakness
Stroke
Other neurological conditions
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Other useful information for referring practitioners Not and exhaustive list
Minimum Referral Criteria
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Category 1
(appointment within 30 calendar days)- New diagnosis of epilepsy (confirmed or highly likely)
- First epileptic seizure (as convulsive syncope is a common mimic, may be seen by general medicine prior to neurology, depending on local pathways)
- Frequent seizure activity with current anticonvulsants use
- High seizure frequency without antiepileptic therapy
- Pregnancy in a patient with known epilepsy
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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)
- Suspected non-epileptic attacks*
*Suspected non-epileptic seizures should be triaged according to the social and medical impact of their epileptic-seizure counterparts rather than based on the (suspected) cause
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Category 3
(appointment within 365 calendar days)- Chronic epilepsy without any concerning features. Concerning features include:
- focal deficit post-ictally
- seizure associated with recent trauma
- persistent severe headache > 1 hour post-ictally
- seizure with fever
- Epilepsy advice and management plan including driving recommendations and decreasing anti-epileptic medication
- Chronic epilepsy without any concerning features. Concerning features include:
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
- ELFT FBC
- 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
- EEG results
- Neuroimaging results
- Drug level results (if available)
- Family history
- Drug and alcohol history
- Sleep studies (if available)
- HIV syphilis (if available)
4. Request
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General referral information
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.)
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Notes
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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.
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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.
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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.
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Last updated: 13 June 2023
