Seizures

PAEDIATRIC

  • If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or follow local emergency care protocols or seek emergent medical advice if in a remote region.

    • All children with new onset of clinically obvious epileptic seizures should be referred to emergency for initial assessment, observation and consideration of emergency investigation or management.
    • Any abnormalities on neurological examination, such as: focal weakness, gait disturbance, papilledema, diplopia
    • New onset of focal seizures or
    • A dramatic change in seizure frequency or duration
    • Possible infantile spasms (west syndrome). This may be frequent brief episodes of head bobbing (with or without arm extension) in an infant less than 12-month-old.
    • Refer to local HealthPathways or local guidelines
    • An EEG should be performed only to support a diagnosis of epilepsy in children and young people. If an EEG is considered necessary, it should be performed after the second epileptic seizure but may, in certain circumstances, as evaluated by the specialist, be considered after a first epileptic seizure. An EEG should not be performed in the case of probable syncope because of the possibility of a false-positive result. The EEG should not be used to exclude a diagnosis of epilepsy in a child, young person or adult in whom the clinical presentation supports a diagnosis of a non-epileptic event.
    • Encourage parents to keep diaries of events and video an event if possible
    • In the majority of cases, it is thought inappropriate for children to wait more than 6 months for an outpatient initial appointment
    • Next of kin or person(s) who is legally responsible for patient consent, with the exception of children under guardianship orders with the Department of Child Safety, Seniors and Disability Services, should be present at the first outpatient appointment.
    • If you have a reason to suspect a child in Queensland is experiencing harm, or is at risk of experiencing harm, you need to contact Child Safety Services
    • Statement of intent – the prioritisation of health services for children and young people in the child protection system

    Patient resources

Minimum Referral Criteria
Category 1
(appointment within 30 calendar days)
  • All children with recent onset of clinically obvious seizures
  • Unstable epilepsy requiring re-evaluation and management
  • A child:
    • at risk of entering the child protection system (0 – 18 years of age)
    • currently in out of home care (OOHC) (0 – 18 years of age), or
    • Adolescents transitioning to adult healthcare following an out of home care experience (15 – 25 years of age)
    where they have previously been on a waiting list for this problem and were removed without receiving a service


Children who have been seen by a consultant in emergency with a first seizure may not require a general paediatric review. Most children seen in emergency following an uncomplicated first seizure will be discharged when stable and specialist follow up should be arranged by their GP if required. Investigation and treatment may only be indicated if there is seizure recurrence.
Category 2
(appointment within 90 calendar days)
  • Known epilepsy transferring care from another health service and requires 2 medications to control epilepsy or has poor control of epilepsy.
  • Children with episodes that may be suggestive but are not conclusively epilepsy
  • Child with an uncomplicated first seizure seen in the Emergency Department where a specialist opinion is requested.
Category 3
(appointment within 365 calendar days)
  • Known epilepsy with stable management who are transferring care

Please insert the below information and minimum referral criteria into referral

1. Reason for request Indicate on the referral

  • To establish a diagnosis
  • For treatment or intervention
  • For advice and management
  • For specialist to take over management
  • Reassurance for GP/second opinion
  • For a specified test/investigation the GP can't order, or the patient can't afford or access
  • Reassurance for the patient/family
  • For other reason (e.g. rapidly accelerating disease progression)
  • Clinical judgement indicates a referral for specialist review is necessary

2. Essential referral information Referral will be returned without this

  • Detailed seizure description, duration, frequency, date of onset
  • Associated problems such as cyanosis or injuries during events
  • Details of current medications used to control epilepsy, if any
  • Report presence or absence of concerning features
    • Headaches
    • Focal seizures
    • Personality change
    • Polyuria or polydipsia
    • Recent change in sleep behaviour
    • Recent onset of clumsiness or poor coordination,
    • Unexplained vomiting
  • Confirmation of OOHC (where appropriate)

3. Additional referral information Useful for processing the referral

Highly desirable Information – may change triage category.

  • Additional history of events including post event drowsiness, incontinence or injuries during events
  • Past treatments/medications offered and efficacy Including previous acute anticonvulsant management
  • Other neurological or development conditions present
  • Either:
    • current developmental status (age appropriate, some delay, significant delay) OR
    • brief comment on current school educational attainments (good, average, poor, very poor [>2 years behind])
  • Any previous EEG results (note advice on ordering EEGs in other useful information section. Generally, it is not required to order an EEG for referral. If previous results are available, please include with referral)

Desirable Information- will assist at consultation.

  • Other past medical history
  • Immunisation history
  • Developmental history
  • Medication history
  • Significant psychosocial risk factors (especially parents mental health, family violence, housing and financial stress, Department of Children, Youth Justice and Multicultural Affairs involvement)
  • Height/weight/head circumference and growth charts with prior measurements if available.
  • Other physical examination findings inclusive of CNS, birth marks or dysmorphology
  • Any relevant laboratory results or medical imaging reports, urinalysis result

4. Request

  • Patient's Demographic Details

    • Full name (including aliases)
    • Date of birth
    • Residential and postal address
    • Telephone contact number/s – home, mobile and alternative
    • Medicare number (where eligible)
    • Name of the parent or caregiver (if appropriate)
    • Preferred language and interpreter requirements
    • Identifies as Aboriginal and/or Torres Strait Islander

    Referring Practitioner Details

    • Full name
    • Full address
    • Contact details – telephone, fax, email
    • Provider number
    • Date of referral
    • Signature

    Relevant clinical information about the condition

    • Presenting symptoms (evolution and duration)
    • Physical findings
    • Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
    • Body mass index (BMI)
    • Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
    • Current medications and dosages
    • Drug allergies
    • Alcohol, tobacco and other drugs use

    Reason for request

    • To establish a diagnosis
    • For treatment or intervention
    • For advice and management
    • For specialist to take over management
    • Reassurance for GP/second opinion
    • For a specified test/investigation the GP can't order, or the patient can't afford or access
    • Reassurance for the patient/family
    • For other reason (e.g. rapidly accelerating disease progression)
    • Clinical judgement indicates a referral for specialist review is necessary

    Clinical modifiers

    • Impact on employment
    • Impact on education
    • Impact on home
    • Impact on activities of daily living
    • Impact on ability to care for others
    • Impact on personal frailty or safety
    • Identifies as Aboriginal and/or Torres Strait Islander

    Other relevant information

    • Willingness to have surgery (where surgery is a likely intervention)
    • Choice to be treated as a public or private patient
    • Compensable status (e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.)

  • If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or follow local emergency care protocols or seek emergent medical advice if in a remote region.

    • Please note that where appropriate and where available, the referral may be streamed to an associated public allied health and/or nursing service.  Access to some specific services may include initial assessment and management by associated public allied health and/or nursing, which may either facilitate or negate the need to see the public medical specialist.

    • A change in patient circumstance (such as condition deteriorating, or becoming pregnant) may affect the urgency categorisation and should be communicated as soon as possible.

    • 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.

Last updated: 4 December 2024

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