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Assessment and management of complex and refractory epilepsy
North South North West Statewide
THS Southern Region
For chronic and drug-resistant epilepsy.
Most first seizures and routine epilepsy cases are seen in the general Neurology Clinic.
THS Northern Region
Epilepsy is seen in Neurology Clinics.
THS North West Region
North West runs an Epilepsy Clinic once a fortnight either face to face or Tele health.
Emergency conditions/symptoms include (not an exhaustive list), proceed to Emergency Department:
- Status epilepticus; single prolonged seizure (>five minutes) or recurrent seizures without regaining consciousness between seizures
- Epileptic patient vomiting or too unwell to take medication
- Epilepsy with significant fever
Urgent conditions/symptoms include:
- Persistent severe postictal headache
- Worsening of postictal mental state
Urgent referrals should be accompanied by a phone call, as per below.
A referral (preferably faxed) is required for all new appointments and must conform to the Referral Standards as outlined on For Clinicians.
Please ask witness to co-attend or be reachable by telephone.
Referral history should include:
- Reason for referral: the complexity, chronicity, uncontrolled seizures, change in pattern
- Medications currently taking
- Medications previously tried, their doses and reason for stopping
- Witness description of events (and asking a witness to co-attend or be reachable by telephone)
- It is preferable the patient and significant others keep a seizure diary.
- CT scan or MRI if indicated e.g. focal deficit postictally, persistent altered mental state postictally, fever, recent trauma, persistent severe headache
- Drug levels if pregnant, on contraceptive pill and lamotrigine, intermittent compliance is suspected, toxicity is suspect or the patient is on phenytoin (in general, levels outside parameters have limited role in management).
- A request for an EEG (fax 6222 8691) if the patient has not had one before, events are frequent, their nature is uncertain, it is many years since they have had one or they are seizure free for 10 years and seek a commercial driver's licence.
All referrals are triaged and allocated according to clinical guidelines as urgent or non-urgent. A written referral stated urgent does not guarantee urgent attention.
Clinic Appointments – Appointments are based on clinical priority:
Proceed to Emergency Department (ED). Please contact ED Medical Officer in Charge:
LGH ED – Phone: (03) 6777 6405 Fax: (03) 6348 7382
MCH ED – Phone: (03) 6478 5120 Fax: (03) 6426 5115
NWRH ED – Phone: (03) 6493 6000 Fax: (03) 6430 6691
RHH ED - Phone: (03) 6166 6100 Fax: (03) 6222 8919
Urgent / category 1
Urgent referrals should be accompanied by a phone call, as per below:
If you would like to discuss a patient for advice or you feel they need earlier review please either:
- Fax a complete Neurology Advice Request Form: the patient's treating Neurologist, Neurology Registrar or on-call Neurologist will contact you by phone within one to two days
- Contact the Neurology Registrar directly within hours via the RHH switchboard Phone: (03) 6166 8308
We will endeavour to see these patients within four weeks, or sooner if clinically indicated.
Routine / category 3
Next available appointment
For use by health professionals only
Direct link to Health Pathways Epilepsy in Adults page
Epilepsy and Driving
Most patients with epilepsy don't require specialist review for assessment of fitness to drive, and most assessments can be completed by a general practitioner.
The guidelines are clear and are available in Assessing Fitness to Drive, 4th edition, produced by Austroads. This is available on the internet at www.austroads.com.au.
Specialist assessment is typically required for initial assessment for a commercial license, or when exceptional circumstances apply (i.e. if patient's condition or circumstances are not specifically covered by guidelines, or there is doubt about the patient's fitness to drive
RHH Neurophysiology, including EEG Referral template
For use by health professionals only