When should I consider referring a patient with epilepsy to a specialist for further evaluation or treatment?

Consider referring a patient with epilepsy to a specialist for further evaluation or treatment in the following situations:

• Urgently (within 2 weeks) after a first suspected epileptic seizure for assessment and diagnosis by a clinician with expertise in epilepsy (adult) or a paediatrician with expertise (children and young people) ¹,².
• If there is a seizure recurrence after a period of remission, urgent referral (within 2 weeks) is recommended ¹,².
• When there is uncertainty about the diagnosis, seizure type, or epilepsy syndrome, or if the epilepsy is drug resistant or treatment causes intolerable side effects, refer to a tertiary epilepsy service to be seen within 4 weeks ².
• If further specialized assessment or treatment is indicated, such as video EEG telemetry, neuropsychology, neuropsychiatry, specialized neuroimaging, epilepsy surgery, vagus nerve stimulation, or ketogenic diet ².
• For children under 3 years, or under 4 years with myoclonic seizures, or with unilateral structural lesions, or showing deterioration in behaviour, speech, or learning, urgent referral to a tertiary paediatric epilepsy service within 2 weeks is advised ².
• If the patient has memory or cognitive deficits or decline, refer for neuropsychological assessment ¹.
• When considering withdrawal of antiepileptic drug treatment after at least two years seizure-free, specialist advice and management is recommended ¹.
• Women with epilepsy planning pregnancy should have their diagnosis and treatment reviewed by specialist services before conception ¹.

Routine annual review of people with epilepsy should be done in primary care, but referral to specialist services is needed if seizures are uncontrolled, if there are concerns about side effects, or if additional support is required ¹,².