Seizures

Emergency department referrals

All urgent cases must be discussed with the on-call Registrar to obtain appropriate prioritisation and treatment.

Contact through:

Caboolture Hospital (07) 5433 8888
Redcliffe Hospital (07) 3883 7777
The Prince Charles Hospital (07) 3139 4000

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.

All children with new onset of clinically obvious epileptic seizures should be referred to emergency for initial assessment, observation and consideration of emergency investigation or management.
Any abnormalities on neurological examination, such as: focal weakness, gait disturbance, papilledema, diplopia
New onset of focal seizures or
A dramatic change in seizure frequency or duration
Possible infantile spasms (west syndrome). This may be frequent brief episodes of head bobbing (with or without arm extension) in an infant less than 12-month-old.

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

All children with recent onset of clinically obvious seizures
Unstable epilepsy requiring re-evaluation and management
A child:
- at risk of entering the child protection system (0 – 18 years of age)
- currently in out of home care (OOHC) (0 – 18 years of age), or
- Adolescents transitioning to adult healthcare following an out of home care experience (15 – 25 years of age)
where they have previously been on a waiting list for this problem and were removed without receiving a service

Children who have been seen by a consultant in emergency with a first seizure may not require a general paediatric review. Most children seen in emergency following an uncomplicated first seizure will be discharged when stable and specialist follow up should be arranged by their GP if required. Investigation and treatment may only be indicated if there is seizure recurrence.

Category 2

Appointment within 90 days is desirable

Known epilepsy transferring care from another health service and requires 2 medications to control epilepsy or has poor control of epilepsy
Children with episodes that may be suggestive but are not conclusively epilepsy
Child with an uncomplicated first seizure seen in the Emergency Department where a specialist opinion is requested.

Category 3

Appointment within 365 days is desirable

Known epilepsy with stable management who are transferring care

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

Refer to local HealthPathways or local guidelines
An EEG should be performed only to support a diagnosis of epilepsy in children and young people. If an EEG is considered necessary, it should be performed after the second epileptic seizure but may, in certain circumstances, as evaluated by the specialist, be considered after a first epileptic seizure. An EEG should not be performed in the case of probable syncope because of the possibility of a false-positive result. The EEG should not be used to exclude a diagnosis of epilepsy in a child, young person or adult in whom the clinical presentation supports a diagnosis of a non-epileptic event.
Encourage parents to keep diaries of events and video an event if possible
In the majority of cases it is thought inappropriate for children to wait more than 6 months for an outpatient initial appointment
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
If you have a reason to suspect a child in Queensland is experiencing harm, or is at risk of experiencing harm, you need to contact Child Safety Services.

Referral requirements

A referral may be rejected without the following information.

Essential referral information

History and Examination

Detailed seizure description, duration, frequency, date of onset
Associated problems such as cyanosis or injuries during events
Details of current medications used to control epilepsy, if any
Report presence or absence of concerning features
- Headaches
- Focal seizures
- Personality change
- Polyuria or polydipsia
- Recent change in sleep behaviour
- Recent onset of clumsiness or poor coordination,
- Unexplained vomiting
Confirmation of OOHC (where appropriate)

Additional referral information (useful for processing the referral)

Highly desirable Information – may change triage category.

Additional history of events including post event drowsiness, incontinence or injuries during events
Past treatments/medications offered and efficacy Including previous acute anticonvulsant management
Other neurological or development conditions present
Either:
- current developmental status (age appropriate, some delay, significant delay) OR
- brief comment on current school educational attainments (good, average, poor, very poor [>2 years behind])
Any previous EEG results (note advice on ordering EEGs in other useful information section. Generally, it is not required to order an EEG for referral. If previous results are available, please include with referral)

Desirable Information- will assist at consultation.

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, Seniors and Disability Services involvement)
Height/weight/head circumference and growth charts with prior measurements if available.
Other physical examination findings inclusive of CNS, birth marks or dysmorphology
Any relevant laboratory results or medical imaging reports, urinalysis result

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.

Clinical Modifiers (where relevant)

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

Reason for Referral (essential)

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 Information (essential)

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