When should I consider referring a child with epilepsy to a specialist

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

Refer a child with epilepsy to a specialist for further evaluation or treatment in the following situations:

Urgently (within 2 weeks) after a first suspected seizure, to a paediatrician with expertise in seizure assessment and diagnosis.
Urgently (within 2 weeks) if the child has a seizure recurrence after a period of remission.
To a tertiary paediatric epilepsy service within 2 weeks if the child is under 3 years old.
To a tertiary paediatric epilepsy service within 2 weeks if the child is under 4 years old and has myoclonic seizures.
If the child has a unilateral structural brain lesion.
If the child shows deterioration in behaviour, speech, or learning.
If there is uncertainty about the diagnosis, seizure type, or epilepsy syndrome.
If the epilepsy is likely to be drug resistant, seizures are drug resistant, or treatment causes intolerable side effects.
If further specialized assessment or treatment is indicated, such as video EEG telemetry, neuropsychology, neuropsychiatry, specialized neuroimaging, ketogenic diet, epilepsy surgery, or vagus nerve stimulation.
If the child has a learning disability, physical disability, or mental health problem requiring additional specialist support.

These referrals ensure timely access to specialist evaluation and management tailored to the child's specific needs and epilepsy characteristics .

When should I consider referring a child with epilepsy to a specialist for further evaluation or treatment?