Common Questions About Neurology Referrals: A Q&A With Dr. Jay Alexander

Seattle Children’s Neurology, a division of the Neurosciences Center, is making changes to improve access to specialty care. The scheduling process has been updated to improve efficiency by redesigning the internal triage process so staff can quickly identify patients who need specialty services most urgently. To support these improvements, the team has created several new FaxBacks that provide clear guidance on recommended care options for providers who refer patients for neurological concerns.

We sat down with Dr. Jay Alexander to discuss the new FaxBacks and clarify what services neurology provides so community providers can ensure their patients receive the care they need.

Q: What diagnoses have new Neurology FaxBacks?

We have developed new FaxBacks to clarify and educate on referral pathways for learning disabilities, sensory integration disorder, school issues and memory loss. These are designed to help referring providers assess if Neurology is the best specialty for their patient, or if there is another team that may provide more appropriate care based on their patient’s specific presentation.

Additionally, we have implemented a FaxBack that denies referrals for dysphagia that have not been previously evaluated by Gastroenterology or Otolaryngology, as that condition is most appropriately evaluated by those specialties.

Q: Why did the Neurosciences Center develop educational FaxBacks for these diagnoses?

For these diagnoses, our process hasn’t changed, but the educational FaxBacks were needed to clarify which patients are seen in Neurology. For some of those diagnoses, the patients may be better served by seeing Psychiatry, Neuropsychology or Neurodevelopmental Medicine. These new FaxBacks provide clear guidance on where to refer your patient.

Q: When should a patient be referred to Neurology for developmental delay versus Neurodevelopmental Medicine?

Neurology would like to see any patient with a combination of motor and cognitive or speech delay. Patients with isolated speech delay are best evaluated through Neurodevelopmental Medicine.

Q: When does Neurology see a patient for memory concerns or school performance issues?

Neurology doesn’t see patients for memory issues or school performance issues in the absence of cognitive delays. For patients with cognitive delays, we can see them under the umbrella of “developmental delay.” Patients without cognitive delays should be referred to Psychiatry or Neuropsychology for an assessment. In particular, ADD/ADHD needs to be ruled out in these patients. On a case-by-case basis, patients can be seen by Neurology if there is a progressive decline in cognition or language skills in the absence of ADD/ADHD. If this is applicable to your patient, please list those details in your referral.

Q: If a patient is having headaches with a Chiari malformation, should they be seen by both Neurology and Neurosurgery?

Patients with headaches who have an MRI of the brain consistent with a Chiari malformation should be referred to Neurosurgery first, even if the Chiari is described as “borderline” (5 to 8 mm). Neurosurgery doesn’t require an evaluation by Neurology prior to surgery if the patient has classic symptoms.

Q: Why does Neurology no longer see patients for PANDAS/PANS?

Neurology hasn’t historically seen patients for PANDAS/PANS. When we see patients for tics, parents sometimes mention PANDAS, but this controversial diagnosis is hypothetical and unconfirmed based on the current literature.

Q: When is it appropriate for Neurology to see patients for post-concussive headaches?

Generally, Neurology doesn’t treat patients with post-concussive headaches in the first month or so after injury since many patients improve during this time frame.

Patients with ongoing concussion symptoms should be referred to the Orthopedics and Sports Medicine Concussion Program (sports related) or Rehabilitation Medicine (not sports related). Neurology is typically involved later in the course of a child’s recovery from their concussion, particularly if their headaches do not improve, and our internal providers may refer to Neurology’s Post-Traumatic Headache Clinic for further evaluation and consideration of targeted therapies.