Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
Indications for referring a patient with epilepsy to a specialist for further evaluation include:
- Urgent referral (within 2 weeks) after a first suspected epileptic seizure for assessment and diagnosis by a clinician with expertise in epilepsy (adult neurologist or paediatrician for children) NICE CKS,NICE NG217.
- Seizure recurrence after a period of remission, requiring urgent specialist assessment NICE CKS,NICE NG217.
- Uncertainty about the diagnosis, seizure type, or epilepsy syndrome NICE NG217.
- Presence of an epilepsy syndrome likely to be drug resistant, or if seizures are drug resistant or treatment causes intolerable side effects NICE NG217.
- Need for further assessment or treatment approaches such as video EEG telemetry, neuropsychology or neuropsychiatry assessment, specialised neuroimaging, specialised treatments (e.g., ketogenic diet, epilepsy surgery, vagus nerve stimulation) NICE NG217.
- Eligibility and wish to participate in clinical trials or research studies NICE NG217.
- Children under 3 years, or under 4 years with myoclonic seizures, unilateral structural lesions, or deterioration in behaviour, speech, or learning should be referred to a tertiary paediatric epilepsy service within 2 weeks NICE NG217.
- People with epilepsy and additional needs such as learning disability, physical disability, or mental health problems may require referral for additional specialist support NICE NG217.
Routine annual review in primary care is recommended, but specialist referral is indicated if seizures are uncontrolled, diagnosis is uncertain, or treatment is ineffective or poorly tolerated NICE CKS.