Breakthrough seizures are a common cause of ED visits and hospitalizations in patients with epilepsy.  Infectious etiologies are known to lower seizure threshold. Urinalysis is obtained for all admissions, with reflex to cultures when positive. UTI is often considered the cause of seizure exacerbation and may preclude consideration of other causes. 

This retrospective chart review of subjects with epilepsy identified few older subjects, likely a limitation of the electronic tool. However for the group identified most with AB had alternative causes of the seizures, specifically, medication non-adherence and illicit drug use. This questions of the utility of routine urinalysis in the ED in known epilepsy patients with breakthrough seizures. Additionally, this may limit clinicians from considering other causes and options to maximize seizure care.