Urgent Referrals for Seizure Evaluation to a Tertiary Care Neurology Center

Abstract

This study evaluates the outcome of urgent neurologic referrals. This was a retrospective review of all referrals to the Floating Hospital for Children in 1 month. The total number of patients referred to our center was 223. Amongst those, 108 were new patients and 195 were follow-up visits; 30 patients were deemed urgent, yet 6 of them did not present to their visit. Urgent and routinely scheduled patients were compared based on the need for further evaluation or medication initiation following their visit. The frequency of visit outcomes was statistically similar between urgently and nonurgently referred patients. We did observe though, that diagnostic testing and medication were initiated more frequently for the patients urgently referred for seizure compared with those routinely scheduled patients for seizure evaluation. For this reason, we suggest that pediatric neurologists preferentially should hold clinic space open for urgent referrals for patients with new-onset seizure.

Clinical guideline: management of the first unprovoked epileptic seizure in adults and children

“…Every patient with a first UES must be examined by a neurologist 27 . According to the regional infrastructure, patients must be referred to a secondary or tertiary medical facility if there is any doubt about the type of provoked ES or if there is evidence of cerebral lesion whether it consists of a tumor, hemorrhage, or infection (cysticercosis, toxoplasmosis, or tuberculosis) 28 . Patients that debut with status epilepticus in their first ES must be referred to a specialized facility for treatment as soon as vital signs are stable.…”

“…It is important for patients to also undergo evaluation for seizure simulator conditions, where studies demonstrate that the most common simulator is a syncope reflex (74%) and psychogenic seizures (16%) 32 . The most common symptoms for reference to a secondary or tertiary medical facility are accompanying neurological manifestations, such as cephalea, immediately after the seizure 28 .…”

“…It has been suggested that in locations where a specialized neurological consult is unavailable, a remote consult by a specialist should be established by telephone or by video conference 2 ; this is a common occurrence in subspecialties such as pediatric neurology 33 . Every referral to a tertiary health-care facility must include a complete medical history, specifying medication, semiology of neurological signs and symptoms that may aid in classifying the type of seizure, and the directed diagnostic evaluation 28 .…”

Guía clínica. Manejo de la primera crisis epiléptica no provocada en adultos y niños

“…Todo paciente con una primera CENP debe ser evaluado por un especialista en neurología 28 . En caso de existir duda con respecto al tipo de CEP o con evidencia clínica de ser secundaria a una lesión cerebral, ya sea tumor, hemorragia o infección (cisticercosis, toxoplasmosis, tuberculosis), el paciente debe de ser referido a un segundo o tercer nivel de atención de acuerdo con la infraestructura de la región 29 .…”