Possible Seizures / Paroxysmal Events: Advice for Referrers

Red Flags – These require on the day discussion via Consultant Connect

All Events – in the acute phase:

• Prolonged >5 minutes
• Focal or recurrent
• Incomplete recovery
• Signs of raised ICP, meningism, focal neurological signs· Afebrile seizure in child <2 yr old

Febrile Seizures in the acute phase:

• Less than 6 months
• No source of pyrexia identified
• Concern about serious bacterial infection
• >1 event in 24 hours

Syncopal events

• Whilst lying down
• On exercise/swimming
• Family history of sudden unexplained death
• QTc > 450ms

• Any child who has had an unprovoked epileptic seizure
• Any child with a febrile seizure with features of concern (see red flags above)
• Any child where the diagnosis is unclear
• Any child where there is a concern regarding an underlying cardiac cause/pathology

Consider on the day discussion for potential acute assessment if:

• Possible infantile spasms – further information on infantile spasms can be found here, and it is possible to sign up for an account to view examples of clinical videos
• Any new focal neurology or abnormal conscious level
• Any developmental regression
• Red flags (See above)

Referral not required if no red flags and:

• Short, generalised febrile convulsions in those over 6 months of age
• History consistent with syncope and previous ECG normal
• Reflex anoxic events and previous ECG normal
• History consistent with tics - see pre-referral advice on tics

• Frequency of events
• Age at onset
• Who history from and if they are a first-hand witness of events
• If associated with temperature/illness

Description of Event(s):

If the patient is verbal, get both their recollection of the event and the direct witness history. Were there any pre-syncopal features such as closing in of vision, tinnitus, or abdominal pain?

If the event was witnessed by a friend, teacher, nursery worker it is better to speak directly to them rather than rely on parent/carer report.

• Prior to Event(s) - triggers, activity prior to onset, crying or breath-holding, if the events are in specific location or at specific times e.g. On wakening or during sleep
• During Event(s) – the very first thing noticed, awareness/responsiveness, eyes open or closed, eye deviation, body stiffness, abnormal limb movements, change in colour, change in breathing, salivation, duration
• After Event(s) – what was the child like after the event and for how long
• Take history from patient if possible in addition to witness

General History:

• Any developmental concerns or regression
• Past medical and family history including seizures, ASD, ADHD, and cardiac disease
• If an ECG has been performed

Please record systems, including neurological examination and pupils/fundoscopy if available

Blood pressure if possible

Any birth marks noted

Please advise the parents to video any future events if possible

Parents may be contacted by the paediatric team prior to their appointment to share any videos on a secure platform for appropriate triaging of referrals – This service will require the details of a parent’s name, mobile phone number, and email address

Febrile Convulsion RHC Patient Information

Possible First Seizure Patient Information

STARS - UK - Patient information on Reflex Anoxic Events and Syncope 

SIGN 159 Epilepsy in Children

EpilepsyDiagnosis.org