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 acute onset or subacute rapidly progressive neurological symptoms, including:
- muscle weakness including limbs, bulbar or neck muscles
- ataxia or gait disorder
- acute onset (hours to days) or rapidly progressive neuropathy such as Guillain–Barré syndrome/acute inflammatory demyelinating polyradiculoneuropathy (AIDP) and its variants
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
- Flinders Medical Centre (08) 8204 5511
- diabetic neuropathy for purposes of pain management, consider referral to chronic pain management service if primary care measures not sufficient
- non-disabling or non-progressive peripheral neuropathy should undergo evaluation in the primary care setting with:
- nerve conduction studies
- screening for common causes including diabetes, thyroid dysfunction, alcohol excess and vitamin B12 deficiency
Category 1 — appointment clinically indicated within 30 days
- severe neuropathy of uncertain cause with significant progression within the last 12 weeks
- progressive muscle weakness and wasting suspected to be amyotrophic lateral sclerosis
- progressive peripheral neuropathy with red flag features including:
- subacute onset (weeks to months)
- motor predominant
- non-length dependent pattern (early upper limb and/or proximal lower limb involvement)
- associated systemic symptoms, or
- associated autonomic dysfunction
Category 2 — appointment clinically indicated within 90 days
- suspected or confirmed myopathy including mitochondrial and metabolic myopathies and muscular dystrophies
- suspected neurogenetic disorders such as hereditary neuropathies, ataxias and spinocerebellar ataxias
- disabling slowly progressive neuropathy ≥ 12 months of uncertain cause, despite evaluation in primary care setting, see ‘clinical management advice and resources’
Category 3 — appointment clinically indicated within 365 days
- confirmed hereditary neuropathy requiring ongoing surveillance with or without medical management
- slowly progressive peripheral neuropathy of uncertain cause despite evaluation in primary care setting without significant disability
For information on referral forms and how to import them, please view general referral information.
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
- identify within your referral 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
- alcohol and other drugs history
- clinical history including:
- onset, duration, distribution (parts of body affected) and progression over time
- pain history including type, severity and treatments tried
- level of disability
- nerve conduction study, if available
- screening neurological examination
- peripheral neuropathy screening bloods:
- complete blood examination (CBE)
- electrolytes, urea, creatinine (EUC)
- liver function tests (LFT)
- C-reactive protein (CRP)
- erythrocyte sedimentation rate (ESR)
- antinuclear antibodies
- extractable nuclear antigens
- fasting glucose + glycated haemoglobin test (HbA1c)
- vitamin B12
- thyroid function tests (TFTs)
Additional information to assist triage categorisation
Serum electrophoresis/immunofixation electrophoresis (IEPG) and serum free light chain assay
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.
Prior to considering referral for specialist neurology assessment of neuropathy, it is recommended you assess and optimise management of these common causes:
- diabetes mellitus
- vitamin B12 deficiency
- thyroid disease
- excessive alcohol intake.
Consider allied health input, such as:
- physiotherapy for patients with gait dysfunction or balance issues
- podiatry for patients with sensory loss in their feet
- 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.
Consider whether your patient’s condition affects their fitness to drive as per Austroads Guidelines.
- Austroads - Assessing Fitness to Drive - Other Neurological and Neurodevelopmental Conditions
- Charcot-Marie-Tooth – Neurotoxic Medication List