It seems to me that your doc may have been trying to find that lowest dose that fits your system and case. Too much med is not good either as we all know and also causes more side effects which decreases quality of life. When you reacted to the level by having a seizure, that told you and her that the level was not therapeutic and needed to be adjusted. I know of no other ways to determine if a med is therapeutic other than using efficacy/ effectiveness or by using the stated blood level range that was derived at by using the levels where seizure reduction occurred for that huge group of people in the clinical trials. That won't necessarily be what is best for me though. I have taken Keppra since early in 1999 and have never once had a blood level done. I did have Tegretol levels done when I took it, and I think Trileptal is related. My doc now really doesn't mention changing my dose even if I have auras and she may should but she does listen to me. I will suggest and she works with me. At least you do know that the level of Trileptal you were at was too low for you, and you can adjust it upward with as few side effects possible. If you begin to have mor side effects, she will use what you tell her to adjust it again possibly. That keeps your dosage as tight and as close to your own specific needs as possible at that point in time. Do you have auras to let you know sooner? Tattoo