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.

  • any status epilepticus (convulsive or non-convulsive)
  • any seizure with red flag features, including:
    • first ever seizure
    • seizure with persistent focal neurological deficit
    • seizure associated with recent head trauma
    • seizure with persistent altered or worsening mental status in the post ictal period
    • seizure with persistent severe headache ≥ 1 hour duration
    • seizure with fever
    • history of malignancy or immunosuppression

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


Not all episodes of collapse are suitable for referral to the epilepsy clinic. Please note the following important exclusions:

  • provoked seizures occurring as a result of illicit drug use and/or alcohol withdrawal, consider contacting alcohol and drug information service for guidance and advice on 1300 131 340
  • acute symptomatic seizures e.g. occurring in the setting of severe systemic illness, severe metabolic disturbance or concussion – management of the cause is the mainstay of treatment (clear guidance on relevant driving restrictions can be found in the assessing fitness to drive guidelines under ‘Acute Symptomatic Seizures’)
  • unconscious collapse where no available collateral history or no features to strongly suggest seizure disorder
  • convulsive syncope
  • assessment primarily for purposes of private driving licence renewal – this can be done using the assessing fitness to drive guidelines by the patient’s treating doctor, including their General Practitioner
  • seizures occurring in the setting of advanced dementia – consider referral to geriatric medicine and/or palliative care services
  • nonepileptic (“psychogenic”) seizures:
    • referrals will be considered and triaged according to the social and medical impact of the condition and not the suspected cause
    • where diagnosis already confirmed and appropriate management has already been instituted referral may not be accepted for ongoing follow-up if there is no clear clinical indication

Triage categories

Category 1 — appointment clinically indicated within 30 days

  • new diagnosis of epilepsy (confirmed or highly likely) - contact neurology registrar to discuss initiation of therapy while awaiting review
  • first epileptic seizure
  • frequent epileptic seizure activity despite current antiepileptic therapy
  • frequent epileptic seizure activity without antiepileptic therapy – please contact neurology registrar to discuss initiation of therapy while awaiting review
  • pregnancy in a patient with known epilepsy

Category 2 — appointment clinically indicated within 90 days

  • suboptimal epilepsy control e.g. increased frequency of seizures, change in seizure activity in patient with good adherence to medical treatment
  • suspected non-epileptic attacks, see ‘exclusions and triage categories - exclusions’
  • new onset seizure recently admitted to hospital for which specialist outpatient follow-up treatment/assessment is required if treatment plan in place see ‘exclusions and triage categories - exclusions’
  • known epilepsy in setting of planning pregnancy (not yet pregnant)

Category 3 — appointment clinically indicated within 365 days

  • epilepsy advice and management plan regarding decreasing/withdrawing antiepileptic medication in patient with known well controlled epilepsy
  • specialist assessment for the purpose of obtaining a commercial driver's licence in a patient with previous seizures/epilepsy:
    • booking to be arranged shortly prior to expiry of mandatory non-driving period and electroencephalogram (EEG) to be arranged within 6 months prior to application for conditional commercial licence

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 epilepsy
  • alcohol and other drugs (especially stimulants) history including type, amount and frequency
  • relevant specialist medical reports and discharge summaries, if available
  • clinical history including:
    • detailed description of what is observed by others during attacks, ideally avoid diagnostic labels such as “tonic-clonic” or “absence”
    • duration, frequency and associated triggers for attacks
    • description of post-ictal features, including duration
    • previous investigations and any medications (dose, duration, benefit, side effects)
  • first seizure:
    • complete blood exam (CBE)
    • electrolytes, urea, creatinine (EUC)
    • liver function tests (LFTs)
    • magnetic resonance imaging (MRI) brain, ideally epilepsy protocol with coronal views, including details of provider and accession number
      • if MRI is unable to be accessed, please arrange a computed tomography (CT) brain to exclude an emergency cause of new onset seizures. If appropriate, the triaging clinician may arrange an MRI brain prior to the patient’s appointment
  • concerns of suboptimal medication control:
    • antiepileptic drug level

Additional information to assist triage categorisation

Routine electroencephalogram (EEG).

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.

Telehealth services

Telehealth services are available for rural and remote patients requiring outpatient epilepsy services. Please mention in the referral if this is preferred for your patient.


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

Patients with known epilepsy

Patients with a known diagnosis of epilepsy experiencing a single breakthrough seizure without complication and making a full recovery, may not require hospital presentation or urgent neurology clinic review. Consider:

  • reviewing medication adherence and consider testing drug levels if non-adherence is suspected (serum level monitoring clinically relevant/available for carbamazepine, phenytoin, phenobarbitone, valproate, lamotrigine, oxcarbazepine)
  • optimising current drug therapy/consider increasing dose if already on medication. Contact neurology registrar in patient’s Local Health Network (LHN), or patient’s private Neurologist, to discuss clinical concerns and obtain advice.
  • whether drug-drug interactions could have contributed to change in seizure control e.g. concurrent cytochrome inducers, binding agents
  • treating any intercurrent infections and co-morbidities
  • addressing any lifestyle issues e.g. inadequate sleep, excess stressors, alcohol, recreational drugs

Clinical resources

Consumer resources