Epilepsy and seizures Referral Access Criteria

• Status epilepticus/epilepsy with concerning features:
  
  • Focal deficit post-ictally
  • Seizure associated with recent trauma
  • Persistent severe headache > 1 hour post-ictally
  • Seizure with fever
• Seizure without known history of seizure disorder
• Prolonged post-ictal period
• Seizures due to substance withdrawal

• Nil

• Suspected seizure
• New diagnosis of epilepsy (suspected or confirmed)
• Frequent seizures, particularly convulsive seizures
• Planning for pregnancy or pregnancy with epilepsy
• Advice on, or review of, epilepsy management plan including driving assessment for all drivers, changes to medicines, the management of epilepsy with concurrent conditions

Refer patient to WA State Epilepsy Service (WAAES – SCGH) if the following symptoms apply:

• Drug resistant epilepsy (i.e. failure to respond to two antiepileptic drugs)
• Epilepsy in conjunction with other issues, complications or comorbidities requiring the care of an epileptologist
• Vagal nerve stimulator or other specialised therapies requiring care by an epileptologist (e.g. ketogenic diet)
• Requires epilepsy surgery and/or a neurosurgical procedure that involves intraoperative monitoring (IOM)
• Requires diagnostic and/or pre-surgical video electroencephalogram (EEG) monitoring

This information is required to inform accurate and timely triage. If unable to attach reports, please include relevant information/findings in the body of the referral and advise where (provider) investigation/imaging was completed.

• Relevant history, onset and duration of symptoms including:
  
  • Date of most recent seizure
  • Current seizure frequency and nature of seizures (tonic-clonic etc.)
• Details of previous and current treatment and outcome
• Current medication list including current antiepileptic drugs with doses and any previously used antiepileptics, including compliance
• History of substance abuse (alcohol, drugs or other chemicals) if applicable

Referrals for Transition from Perth Children’s Hospital (PCH) to the WA State Epilepsy Service (WAAES – SCGH):

• All new referrals from PCH need to be planned at least 12 months ahead of transition to the Adult Epilepsy Service. PCH is to continue care until first appointment with the Adult Epilepsy Service. All referrals are to be directed to the Adult Epilepsy Service and not to any named doctor, unless specifically discussed with one of the team.
• The referral letter must include the completed Epilepsy History Form.
• Other medical or allied services involved in the patient’s care (e.g. psychiatry, gastroenterology, dietetics, disability service, rehabilitation medicine) need to be stipulated in the referral letter.

• Nil

• Nil             

• Previous investigations (i.e. MRI, EEG)
• Seizure charts
• Indicate whether the patient has previously attended neurology clinic or seen a neurologist
  • If so please attach contact details, dates and any other information and correspondence relating to these visits

• Nil

• FBC
• LFTs
• U&Es
• Vitamin D
• Antiepileptic drug serum level results

Category 1

Appointment within 30 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)
• Pregnancy in a patient with known epilepsy            

Category 2

Appointment within 90 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          

Category 3

Appointment within 365 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 neurological conditions that are well controlled and do not require additional intervention (e.g. chronic epileptic patient on stable drug therapy and no seizures for 10 years)
  
  • See Clinician Assist WA: Epilepsy in Adults (external site)             

• Nil