Neurology non-urgent referrals from General Practitioners

Inclusion criteria

Patients aged 16 years or older with complex neurological conditions.

Note: paediatric referrals are managed by PMH/PCH Neurology or FSH Paediatric Department as per catchment and subspecialty availability.

Exclusion criteria

• Acquired brain injury – specific exclusions:
  • Chronic sequelae of acquired brain injury, with the exception of epilepsy.
  • Post-concussion or rehabilitation of acquired brain injury (consider referral to Rehabilitation Medicine / Community Rehabilitation / Day Therapy / State Head Injury Unit as appropriate).
• Bell’s palsy – routine follow-up.
• Botulinum therapy for migraines.
• Certification of a patient’s ability to drive, for private standards, in the presence of a neurological condition unless specified as a requirement by the Department of Transport (see Austroads Guidelines (external site) for assessing the fitness to drive).
• Chronic headache where standard treatment has not been tried.
• Chronic low back pain, neck pain or radicular pain; chronic pain or non-specific pain syndromes (consider referral to pain services as appropriate).
• Chronic neurological conditions that are well controlled and do not require additional intervention e.g. chronic epileptic patient on stable drug therapy and no seizures for 10 years, do not need to be referred for ‘routine’ review.
• Cognitive impairment > 65 y.o.a. (consider referral to geriatric medicine and aged care services as appropriate).
• Lyme disease or Lyme-like illness.
• Fibromyalgia/Chronic Fatigue Syndrome (consider referral to rheumatology/pain services as appropriate).
• Neurological symptoms due to treatment non-adherence, e.g. seizures.
• Parkinson’s disease > 65 y.o.a. unless referred by specialist (consider referral to geriatric medicine/community rehabilitation/day herapy Unit as appropriate).
  • Patients with long history of distal symmetrical painful sensory neuropathy associated with diabetes or alcoholism referred for pain management (consider referral to Chronic Pain service).
  • Previous diagnosis of small fibre neuropathy (Note: RPH will accept these patients if referred by a neurologist).
• Seizures known to relate to drug/alcohol use (consider referral to drug and alcohol services as appropriate).
• Sleep disorders (consider referral to sleep medicine as appropriate).
• Syncope (consider medical or cardiology referral as appropriate).
• Tremor of long duration or milder severity.
• Vertigo with hearing loss (consider ENT referral as appropriate).
• Workers compensation and medico-legal cases.

Neurology referrals are triaged according to relative urgency based on:

• presenting symptoms, probable diagnosis and its potential seriousness
• how long the symptoms have been present
• severity and impact of the symptoms in the patient
• comorbidities.

If you are uncertain about the appropriateness of your referral, please phone the on-call neurology registrar to discuss. Your enquiry will be escalated to the on-call consultant in cases where uncertainty remains.

Routine referrals should be submitted via CRS using the standard referral form.

In addition to the standard CRS referral information (patient demographics, medications, allergies, etc):

• reason for referral – comprehensive description including:
  
  • presenting symptoms, onset and duration
  • evolution – progressive, stable or improving
  • impact on patient’s life e.g. mobility, falls, employment, ADL’s, weight loss, etc
  • physical examination findings.
• attach copy of results of relevant tests
• indicate whether the patient has previously attended neurology clinic or seen a neurologist, if so where/name/s and attach correspondence.

Epilepsy and seizures

Headache or migraine

Peripheral neuropathy

Progressive loss of neurological function

The Adult Statewide Epilepsy Service is based at Sir Charles Gairdner Hospital.

Inclusions

Patients must meet at least one of the following criteria:

• Drug resistant epilepsy (i.e. failure to respond to two antiepileptic drugs)
• Epilepsy in conjunction with other issues, complications or comorbidities requiring the care of an epileptologist
• Requires epilepsy surgery and/or a neurosurgical procedure that involves intraoperative monitoring (IOM)
• Requires diagnostic and/or pre-surgical video EEG monitoring
• Vagal nerve stimulator or other specialised therapies requiring care by an epileptologist (e.g. ketogenic diet)

Referral instructions

In addition to the ‘required information’ above, referrals must state which criterion is met.

The Cognitive Dementia and Memory Service (CDMS) is based at Royal Perth Hospital.

Inclusions

• Patients within RPH catchment referred by GP or
• Patients in all catchments referred by a neurologist, geriatrician, psychiatrist or rehabilitation physician

that meet the following criteria:

• Aged 34-65 y.o.a. with impairment on screening (MoCA or MMSE)
• Aged >65 y.o.a. with MMSE greater than 23/30.

Exclusions

• Patients aged > 65 y.o.a. with MMSE less than 23/30 (refer to local geriatric medicine memory clinic)
• Patients whose primary and major diagnosis/ symptomatology are alcohol, drug or psychiatry related (consider referral to drug and alcohol service or mental health service as first line – these may subsequently refer to CDMS as appropriate).

Referral instructions

In addition to the ‘required information’ above, provide:

• Essential information:
  • result of cognitive screening – preferably MMSE.