Epilepsy Referral Criteria for Pediatric Neurology

Introduction to Epilepsy Referral

The American Academy of Pediatrics recommends that infants, children, and adolescents with intractable epilepsy being considered for epilepsy surgery should be referred to a neurosurgeon with experience in epilepsy surgery 1, 2

Patients with refractory or intractable epilepsy, defined as those who have failed two or more appropriate antiepileptic drugs, require evaluation by pediatric neurology to consider surgical options, dietary therapies, or neuromodulation 1, 2
Any child presenting with focal postictal deficits that do not resolve quickly or who has not returned to baseline several hours after the seizure requires emergency neuroimaging and neurological evaluation 3, 4
Children with significant cognitive or motor decline of unknown etiology, unexplained abnormalities on neurological examination, or partial-onset seizures with or without secondary generalization should be referred 3, 4

All infants with non-febrile seizures should be considered for non-urgent neuroimaging with magnetic resonance imaging (MRI) as the preferred modality 3, 4
Children with partial-onset seizures require specialized evaluation, as they may indicate structural lesions that require MRI 3, 4
An electroencephalogram (EEG) that does not represent benign childhood partial epilepsy or primary generalized epilepsy requires evaluation by pediatric neurology 3, 4

An EEG is recommended as part of the neurodiagnostic evaluation of a child with an apparent first unprovoked seizure 3, 4
If neuroimaging is obtained, MRI is the preferred modality over computed tomography (CT) 3, 4
Laboratory tests should be ordered based on individual clinical circumstances, including historical or clinical findings suggestive of vomiting, diarrhea, dehydration, or failure to return to baseline alertness 3, 4
Toxicology screening should be considered in the entire pediatric age range if there is any question about drug exposure or substance abuse 3, 4

The American Heart Association notes that epilepsy is a neurological condition that does not require routine cardiac evaluation unless specific cardiac symptoms are present 5