Draft for consultation only
Referral to emergency
If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice if in a remote region.
- sudden onset movement disorder
- acute deterioration in patient with a known movement disorder
- rapidly progressive movement disorder over days to weeks, especially if associated with cognitive change or new neurological signs
For clinical advice, please telephone the relevant metropolitan Local Health Network switchboard and ask to speak to the relevant specialty service.
Central Adelaide Local Health Network
- Royal Adelaide Hospital (08) 7074 0000
- The Queen Elizabeth Hospital (08) 8222 6000
Northern Adelaide Local Health Network
- Lyell McEwin Hospital (08) 8182 9000
- Modbury Hospital (08) 8161 2000
Southern Adelaide Local Health Network
- Flinders Medical Centre (08) 8204 5511
- classical essential tremor which has not been trialled on propranolol (unless considered contraindicated)
- patients seeking predictive genetic testing for Huntington disease – consider referral to the South Australian Huntington's Disease Service at the Repat Health Precinct. Referrals should be faxed to the Huntington Disease Social Workers: (08) 7117 5081.
Category 1 — appointment clinically indicated within 30 days
- subacute progressive movement disorder (with or without cognitive change) deteriorating over weeks - contact neurology registrar to discuss clinical concerns and obtain advice
Category 2 — appointment clinically indicated within 90 days
- patients fulfilling category 2 or 3 referral criteria will be triaged depending on rapidity of progression, and degree of functional limitation associated with their presentation
- known or suspected:
- Parkinson’s disease
- atypical Parkinsonian syndromes (including progressive supranuclear palsy, corticobasal degeneration, multiple systems atrophy and drug-induced syndromes)
- hyperkinetic movement disorders including chorea, tics (and Tourette syndrome), myoclonus and dystonia
- Huntington’s disease
- tardive dyskinesia
- gait disorders of uncertain aetiology
- disabling tremor
Category 3 — appointment clinically indicated within 365 days
- as identified in triage categories – category 2
For information on referral forms and how to import them, please view general referral information.
Essential referral information
Completion required before first appointment to ensure patients are ready for care. Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally.
- complete past medical history
- current medication list including non-prescription medication, herbs and supplements
- family history of movement disorders e.g. Huntington’s disease, Parkinson’s disease
- psychiatric history
- alcohol and other drugs (especially stimulants) history
- clinical history including:
- onset and progression of movement disorder
- nature of symptoms and signs observed
- frequency and duration for intermittent symptoms
- medications trialled
- associated features and degree of functional impairment
- allied health reports (if available)
- screening neurological examination
Additional information to assist triage categorisation
- thyroid stimulating hormone (TSH)
- thyroxine level
- electrolytes, urea, creatinine (EUC)
- liver function tests (LFT)
any relevant medication (drug) levels including:
Clinical management advice
Not all referrals require consultation with a neurologist and patients may be reviewed in advanced practice nurse led clinics where medically appropriate. Nurse led clinics are part of best evidence-based practice and have been shown to reduce patient wait times, increase consultation duration, increase patient engagement and satisfaction; improve communication and provide access to tailored advice on self-management of disease and illness.
If the patient you are referring requires urgent attention and/or fulfils category 1 triage criteria, it is strongly recommended that you contact the outpatient department to ensure your referral has been received.
Triaging of suspected or diagnosed movement disorders to the subspecialty clinic is dependent on the rapidity of progression and/or degree of associated disability and is at the discretion of the triaging clinician.
In genetically confirmed Huntington disease: consider referral to the South Australian Huntington's Disease Service at the Repat Health Precinct for community supports.
Referrals should be faxed to the Huntington Disease Social Workers on (08) 7117 5081.
Prior to referral for tremor, consider whether it may be related to a current medication(s). Common drugs which induce tremor include beta agonists, antiemetics, antiepileptic and antipsychotic medications.
Consider whether your patient’s condition affects their fitness to drive as per Austroads Guidelines.
Consider allied health input, such as:
- physiotherapy for patients with gait dysfunction or balance issues
- occupational therapy for patients with disability impacting their activities of daily living.
There are private and public options for accessing allied health services. For additional support in locating a suitable service in regional, rural and remote South Australia, contact the Country Referral Unit.
Telehealth services may be available for rural and remote patients requiring outpatient movement disorders services. Please mention in the referral if this is preferred.
- HealthPathways SA - Parkinson's Disease (log in required)
- Austroads - Assessing Fitness to Drive – Other Neurological and Neurodevelopmental Conditions
- Parkinson’s Australia – Information for GPs
- Brain Foundation – Essential Tremor