EPILEPSY PATIENT REFERRAL PATHWAY

Note: This referral pathway has been endorsed by the EITF and Provincial Neurosurgery Advisory Committee (PNAC). These recommendations are not intended to supersede existing referral relationships. Referring practitioners are encouraged to check with DECs for average wait times when making referrals. Where possible, it is suggested to offer patients options to enhance their timely access to care.

PRIMARY CARE PROVIDER COMMUNITY NEUROLOGIST DISTRICT EPILEPSY CENTRE / REGIONAL EPILEPSY SURGERY CENTRE

Patient has experienced one or more epileptic

seizures

Patient history- Neurologic examination- Brain MRI (if indicated, e.g., if new onset focal seizures)- EEG

Treatment by anti-epileptic drugs (AEDs)

Patient seizures notcontrolled by first AED

Epilepsy diagnosis?

Follow alternate diagnostic / treatment protocols

Monitorpatient

Refer to communityneurologist or DEC

NONO

YES

2nd AED effective?

Patient experiencing drug-resistant epilepsy

Patient admitted to epilepsy monitoring unit (EMU) for

assessment

YES NO

Refer to epileptologist at

DEC/RESC for treatment options

Diagnosis ofdrug-resistant

epilepsy

YES NO

Decision to treat-surgery?

YES

Patient referred back to DEC for other

treatment options

Obtain patient consent, proceed with

scheduling surgery

Local Health Integration Network (LHIN)

CentralCentral EastSouth EastChamplainNorth Simcoe MuskokaNorth EastNorth West

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PEDIATRIC ADULTDEC RESC DEC RESC

Local Health Integration Network (LHIN)

Erie St. ClairSouth WestWaterloo WellingtonHNHBCentral WestMississauga HaltonToronto Central

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Patient referred back to neurologist

with treatment recommendations

Possible surgical

candidate?

NO

AEDtreatment effective?

Decision point

Referral pointDiagnosis/Treatment

Referral point to community agency

Monitorpatient

Refer to community epilepsy agency

YES

NO

Refer toRESC

EMU stay at DEC

Try 2nd AED

YES

Lesion on MRI / CT ?

Version 1.0 (March 2018)