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2.4 Referrals

Relevant Tools: A.4, A.17

Once shared-care protocols have been established, members of the primary care team should be clear about to whom their patients with epilepsy should be referred. Ideally, patients should be referred to a specialised epilepsy service. However, if there is no such service in the area, or access is limited, patients should be referred to a general practitioner with a special interest in epilepsy if possible.1 Patients can make use of the Department of Health's Choose and Book facility whereby patients who need an outpatient appointment can go online and choose which hospital they are referred to by their GP. They can then also book a convenient date and time for their appointment.

Patients should be referred to a specialist for review of their epilepsy in the following instances:

  • after any suspected first or new onset seizure(s), the NICE and SIGN guidelines recommend that services should be provided that enable patients to be seen by a specialist within two weeks of onset2-4
  • especially important for patients in whom a brain tumour is suspected, for whom urgent referral under the two-week cancer standard is recommended, including people with one or more of the following:
    • focal seizures
    • prolonged post-ictal (after the seizure) focal deficit (longer than one hour)
    • status epilepticus
    • associated inter-ictal (between seizure) focal deficit4
  • to consider the risks and benefits of drug withdrawal. The consequences of poor advice at this stage can be profound5
  • to manage specific problems or conditions such as drug side-effects, psychiatric issues, pregnancy and related issues, social issues, genetic advice and mental deterioration5
  • to monitor the underlying cause if it is potentially progressive5
  • if seizure control in established epilepsy is unsatisfactory and the patient is willing to explore potential treatment options or further investigations
  • if there is a change from baseline seizure frequency without other cause, and the patient wishes to explore treatment options
  • if seizures are not controlled and/or there is diagnostic uncertainty or treatment failure, in which case referral to tertiary services may be necessary.2

For more information, see the Epilepsy Action tools for assisting epilepsy management in primary care.

References

1 Royal College of General Practitioners/Department of Health, 2003. Guidelines for the appointment of general practitioners with special interests in the delivery of clinical services: Epilepsy. [online] (Accessed 03/04/2012).

2 National Institute for Health and Clinical Excellence (NICE), 2012. The epilepsies: The diagnosis and management of the epilepsies in adults and children in primary and secondary care. [CG137]. London: NICE.

3 Scottish Intercollegiate Guidelines Network (SIGN), 2003. Diagnosis and management of epilepsy in adults. A national clinical guideline. Edinburgh: SIGN.

4 Department of Health, 2000. Referral Guidelines for Suspected Cancer. London: DOH.

5 Epilepsy Action, 2005. Role of Primary Care in Epilepsy Management 2. Leeds: Epilepsy Action.

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