Clinical | Department of Medicine | School of Medicine

The division provides a full spectrum of neurological consultative services for patients in southeastern Ontario. Patients are seen only with physician referral.

The Division provides specialized outpatient clinics in several areas of subspecialty neurology as well as general clinics. An urgent clinic is also available. These clinics are located at Kingston General Hospital. There are outreach clinics in Smith's Falls and Brockville.

The inpatient neurology service is integrated with neurosurgery at KGH, along with the neurosciences critical care unit. Consultation service for inpatients is provided by the Division in the Queen's University teaching hospitals. There is an active academic program in neuropathology also located at KGH. The Division provides clinical neurophysiology services for the teaching hospitals and several community hospitals. Kingston General Hospital is the site of a Regional Stroke Program, funded by the Ministry of Health.

Referring Physician Information

Download the referral form for 'New Neurological Consults". Please complete and fax to 613-548-6137.

Patient Information

Info here

First Seizure Clinic

The First Seizure clinic at Kingston Health Sciences Centre run by Dr. Winston provides rapid neurological assessment of adult patients presenting with a first suspected seizure to determine if the event was a seizure or a mimic (such as vasovagal syncope), and if it was a seizure to perform risk stratification and determine if treatment is recommended.

Referrals

Referrals are primarily from Emergency Departments or Family Physicians across South-Eastern Ontario. Given a common clinical presentation and large catchment area, only referrals meeting the criteria below will be seen as a priority. Other referrals will be redirected as appropriate to routine epilepsy or general neurology.

Note that patients require an EEG before they will be booked in the clinic. To book an EEG at KHSC, please see https://kingstonhsc.ca/healthcare-providers/booking-eeg-services-physicians

Brain imaging should also be performed (at least a CT brain, but ideally also an MRI brain).

Criteria For Referral

Adult patient (18 years or over)	If younger than 18 years, refer to pediatric neurology or general pediatrics
First episode of suspected seizure	If recurrent events, then refer to epilepsy or general neurology; given wait times consider discussing with on call neurology regarding starting treatment
Without access to a neurologist	If patient has already been assessed by neurology, or has a neurologist, request should be directed to that neurologist
Not provoked	The clinic does not review alcohol-withdrawal or drug-induced seizures
Not currently on or starting treatment	The aim of the clinic is to determine if treatment is required, so if a clear etiology requiring treatment is present (e.g. seizure from stroke) then refer to epilepsy after starting treatment

Referrals to the clinic can be directed to the central neurology intake fax at 613-548-6137.

Vasovagal Syncope

Historically, around a third of referrals have a diagnosis other than seizure. The most common is vasovagal syncope from cerebral hypoperfusion. A prodrome of lightheadness, feeling hot or cold, diaphoresis, palpitation, closing in of vision or pallor with a brief loss of consciousness and rapid recovery are suggestive of this diagnosis. A few myoclonic jerks may occur but are not sustained. Evaluation should include postural BP and ECG.

Useful information and references to consider this diagnosis are available at:

https://www.ncbi.nlm.nih.gov/books/NBK470277/

https://www.nursingcenter.com/ncblog/august-2019/syncope-or-seizure