What are the indications for referring a patient with epilepsy to a specialist for further evaluation?

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) ¹,².
• Seizure recurrence after a period of remission, requiring urgent specialist assessment ¹,².
• Uncertainty about the diagnosis, seizure type, or epilepsy syndrome ².
• Presence of an epilepsy syndrome likely to be drug resistant, or if seizures are drug resistant or treatment causes intolerable side effects ².
• 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) ².
• Eligibility and wish to participate in clinical trials or research studies ².
• 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 ².
• People with epilepsy and additional needs such as learning disability, physical disability, or mental health problems may require referral for additional specialist support ².

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 ¹.