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Seizures/Epilepsy

Emergency department referrals

All urgent cases must be discussed with the on call Neurology Registrar to obtain appropriate prioritisation and treatment. Contact through:

  • Royal Brisbane and Women's Hospital (07) 3646 8111
  • The Prince Charles Hospital (07) 3139 4000
  • Redcliffe Hospital (07) 3883 7777

Urgent cases accepted via phone must be accompanied with a written referral and a copy faxed immediately to the Central Patient Intake Unit: 1300 364 952.

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

  • 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

Does your patient wish to be referred?

Minimum referral criteria

Does your patient meet the minimum referral criteria?

Category 1

Appointment within 30 days is desirable

  • 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 with 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 days is desirable

  • 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 days is desirable

  • Chronic epilepsy without concerning features. Concerning features include:
    • Persistent 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

If your patient does not meet the minimum referral criteria

Consider other treatment pathways or an alternative diagnosis.

If you still need to refer your patient:

  • Please explain why (e.g. warning signs or symptoms, clinical modifiers, uncertain about diagnosis, etc.)
  • Please note that your referral may not be accepted or may be redirected to another service

Other important information for referring practitioners

Not an exhaustive list

  • Refer to HealthPathways for assessment and management information if available
  • 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

Referral requirements

A referral may be rejected without the following information.

Essential referral information

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

Additional referral information (useful for processing the referral)

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

Out of catchment

Metro North Health is responsible for providing public health services to the people who reside within its boundaries. Special consideration is made for patients requiring tertiary care or services that are not provided by their local Hospital and Health Service. If your patient lives outside the Metro North Health area and you wish to refer them to one of our services, inclusion of information regarding their particular medical and social factors will assist with the triaging of your referral.

  • 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

  • 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

  • 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

  • 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

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

  • 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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