Referral criteria from primary care - epilesy or seizure (or fit)

Following a suspected seizure:

• in adults
  • recommended that people having a first seizure should be seen as soon as possible by a specialist in the management of the epilepsies to ensure precise and early diagnosis and initiation of therapy as appropriate to their needs.
  • the diagnosis of epilepsy in adults should be established by a specialist medical practitioner with training and expertise in epilepsy (1,2)
    • it is recommended that people having a first seizure should be seen as soon as possible by a specialist in the management of the epilepsies to ensure precise and early diagnosis and initiation of therapy as appropriate to their needs (1)
    • treatment with antiepileptic drugs (AEDs) should only be initiated in exceptional circumstances
• in children
  • recommended that all children who have had a first non-febrile seizure should be seen as soon as possible by a specialist in the management of the epilepsies to ensure precise and early diagnosis and initiation of therapy as appropriate to their needs
  • the diagnosis of epilepsy in children should be established by a specialist paediatrician with training and expertise in epilepsy (1,2)
    • it is recommended that all children who have had a first non-febrile seizure should be seen as soon as possible by a specialist in the management of the epilepsies to ensure precise and early diagnosis and initiation of therapy as appropriate to their needs (1)

Patients with a diagnosis of epilepsy:

• if seizures are not controlled and/or there is diagnostic uncertainty or treatment failure, individuals should be referred to secondary or tertiary care soon for further assessment
• if there are specific medical or lifestyle issues (for example pregnancy or drug cessation)

Notes:

• diagnosis of epilepsy requires specialist review as soon as possible. NICE have recommended review within two weeks (1,2)
• criteria for urgent referral for a suspected seizure in context of a possible brain tumour is linked.

Reference:

1. NICE (October 2004).The epilepsies: the diagnosis and management of the epilepsies in adults and children in primary and secondary care.
2. NICE (April 2018). Epilepsies: diagnosis and management