When should I consider referring a patient with temporal lobe epilepsy to a neurologist for further evaluation?

You should consider referring a patient with temporal lobe epilepsy to a neurologist for further evaluation in several key situations:

• Seizure Recurrence: Refer urgently (within 2 weeks) if the patient experiences a seizure recurrence after a period of remission ².
• Ongoing Seizures and Unclear Diagnosis: If seizures are ongoing despite treatment and the diagnosis remains unclear, consider an additional review of MRI scans by a specialist in paediatric or adult neuroradiology within a tertiary centre ².
• New Features: Consider an additional MRI scan if there are new features to their epilepsy ². This would typically warrant specialist review.
• Considering Surgery: An additional MRI scan should be considered if surgery is being considered for their epilepsy ².
• Genetic Testing: Discuss with a neurologist or geneticist any uncertainties about whether to offer genetic testing or which tests to offer to a person with epilepsy ².

Initial referral for a first suspected seizure, or for features strongly suggestive of epileptic seizures (such as a bitten tongue, head-turning to one side during transient loss of consciousness, or confusion following the event), should also be made urgently to a clinician with expertise in assessing first seizures and diagnosing epilepsy ¹,².