Referral to emergency

If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice if in a remote region.

  • sudden onset movement disorder
  • acute deterioration in patient with a known movement disorder
  • rapidly progressive movement disorder over days to weeks, especially if associated with cognitive change or new neurological signs

For clinical advice, please telephone the relevant metropolitan Local Health Network switchboard and ask to speak to the relevant specialty service.

Central Adelaide Local Health Network

Northern Adelaide Local Health Network

Southern Adelaide Local Health Network

Exclusions

  • classical essential tremor which has not been trialled on propranolol unless considered contraindicated
  • patients seeking predictive genetic testing for Huntington disease – consider referral to the South Australian Huntington's Disease Service at the Repat Health Precinct. Referrals should be faxed to the Huntington Disease Social Workers on (08) 7117 5081.

Triage categories

Category 1 — appointment clinically indicated within 30 days

  • subacute progressive movement disorder (with or without cognitive change) deteriorating over weeks - contact neurology registrar to discuss clinical concerns and obtain advice

Category 2 — appointment clinically indicated within 90 days

  • patients fulfilling category 2 or 3 referral criteria will be triaged depending on rapidity of progression, and degree of functional limitation associated with their presentation
  • known or suspected:
    • Parkinson’s disease
    • atypical Parkinsonian syndromes, including progressive supranuclear palsy, corticobasal degeneration, multiple systems atrophy and drug-induced syndromes
    • ataxia
    • hyperkinetic movement disorders including chorea, tics (and Tourette syndrome), myoclonus and dystonia
    • Huntington’s disease
    • tardive dyskinesia
    • gait disorders of uncertain aetiology
  • disabling tremor

Category 3 — appointment clinically indicated within 365 days

  • as identified in triage categories – category 2

For more on outpatient referrals, see the general referral information page.

Essential referral information

Completion required before first appointment to ensure patients are ready for care. Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally.

  • identifies as Aboriginal and/or Torres Strait Islander
  • relevant social history, including identifying if you feel your patient is from a vulnerable population and/or requires a third party to receive correspondence on their behalf
  • interpreter requirements
  • complete past medical history
  • current medication list including non-prescription medication, herbs and supplements
  • family history of movement disorders e.g. Huntington’s disease, Parkinson’s disease
  • psychiatric history
  • alcohol and other drugs especially stimulants history
  • clinical history including:
    • onset and progression of movement disorder
    • nature of symptoms and signs observed
    • frequency and duration for intermittent symptoms
    • medications trialled
    • associated features and degree of functional impairment
    • allied health reports, if available
    • screening neurological examination

Additional information to assist triage categorisation

Any relevant medication (drug) levels including:

  • lithium
  • phenytoin
  • carbamazepine

Tremor

  • thyroid stimulating hormone (TSH)
  • thyroxine level
  • electrolytes, urea, creatinine (EUC)
  • liver function tests (LFT)
  • calcium

Clinical management advice

Not all referrals require consultation with a neurologist and patients may be reviewed in advanced practice nurse led clinics where medically appropriate. Nurse led clinics are part of best evidence-based practice and have been shown to reduce patient wait times, increase consultation duration, increase patient engagement and satisfaction; improve communication and provide access to tailored advice on self-management of disease and illness.

If the patient you are referring requires urgent attention and/or fulfils category 1 triage criteria, it is strongly recommended that you contact the outpatient department to ensure your referral has been received.

Triaging of suspected or diagnosed movement disorders to the subspecialty clinic is dependent on the rapidity of progression and/or degree of associated disability and is at the discretion of the triaging clinician.

Huntington disease

In genetically confirmed Huntington disease: consider referral to the South Australian Huntington's Disease Service at the Repat Health Precinct for community supports.

Referrals should be faxed to the Huntington Disease Social Workers on (08) 7117 5081.

Tremor

Prior to referral for tremor, consider whether it may be related to a current medication(s). Common drugs which induce tremor include beta agonists, antiemetics, antiepileptic and antipsychotic medications.

Driving

Consider whether your patient’s condition affects their fitness to drive as per Austroads Guidelines.

Allied health

Consider allied health input, such as:

  • physiotherapy for patients with gait dysfunction or balance issues
  • occupational therapy for patients with disability impacting their activities of daily living.

There are private and public options for accessing allied health services. For additional support in locating a suitable service in regional, rural and remote South Australia, contact the Country Referral Unit.

Telehealth

Telehealth services may be available for rural and remote patients requiring outpatient movement disorders services. Please mention in the referral if this is preferred.

Clinical resources

Consumer resources