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

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

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

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