How relevant are Keppra blood level tests?

Welcome to the Coping With Epilepsy Forums

Welcome to the Coping With Epilepsy forums - a peer support community for folks dealing (directly or indirectly) with seizure disorders. You can visit the forum page to see the list of forum nodes (categories/rooms) for topics.

Please have a look around and if you like what you see, please consider registering an account and joining the discussions. When you register an account and log in, you may enjoy additional benefits including no ads, access to members only (ie. private) forum nodes and more. Registering an account is free - you have nothing to lose!


Reaction score
Hi all,

I've been on Keppra for almost 12 years, and I think I may have had only two or three blood level tests in that time. I've been fortunate to be well controlled by Keppra and have tolerated it well after my initial years settling in.

A few weeks ago, my doc asked that I do a Keppra blood test since it has been a while. Taking the test before my first morning dose (so 12 hours since my last dose), he said my level was 11.8 on a range of 12 to 46. As a result, he wanted to increase my Keppra dosage.

Does this increase seem warranted and necessary?

My understanding with Keppra is that levels were rarely taken and not always accurate, so the idea was to treat the patient and not adhere to a strict lab guideline.

1. I have not had one seizure episode in the 12 years I've been at my current dosage.
2. Also, I've ready different reference ranges for the same unit of measurement depending on where you get the information. For example, Cleveland Clinic says 5 - 45, Mayo Clinic says 10 - 40, Lab Quest says 12 - 46.
3. I had to wait at the lab for a while, so the time of the test was later than usual, and even then, the result was barely below the "reference range."
4. I've also read that given the difficulty of determining which Keppra level is truly therapeutic, and an article from the NIH stated not to be a slave to those ranges and treat the individual patient based on seizure control and side effects.

Knowing all that, I am pushing back against my doc wanting to increase the level, as it seems a rather arbitrary decision given my strong history of seizure control and good quality of life.

Any thoughts?
BTW, this is what I read on the lab website they had me use. Which seems to support my idea that they should be taking into account the overall context.

"Question 4. How are test results interpreted?​

The therapeutic range of levetiracetam is generally 12 to 46 µg/mL (mg/L) for trough collections. A trough blood concentration >46 µg/mL may be toxic; however, toxic levels are not well established.2 Results should be interpreted in the context of the clinical picture, including evidence of drug effectiveness and/or toxicity.

Most people with blood levels within the therapeutic range will respond to the drug without excessive adverse effects. Individual responses can vary, however, and some patients may require dosages outside of the established range to effectively control seizures and/or limit adverse effects. Dosage is considered adequate if the patient has no recurrent seizures and no significant adverse effects."
If your seizures are under control at the dosage you're taking, if the medication is well tolerated, etc. then I don't see any reason to up the dose.

I know, I'm not a doctor. I didn't go to medical school, but really...what's the point of it? Perhaps they feel it's not meeting "therapeutical" levels or you're having break through seizures so they're like, "Oh no, that's gotta be up there a bit more."

I've had my Keppra dosage taken only once because when I switched neurologist she wanted to know what the level was that worked for me. It was quite low - it was 4.95, I believe. She didn't want to up the dose for me since that was working at that time and I hadn't had an issue in 10 years. Later, I tapered off completely, but now I'm back on it, but the ER version instead of the immediate release, but I'm not 100% sure that's right for me or not.

I suppose it's always possible for tests not to be accurate...there can always be a lot of other factors with blood tests and when the sample is taken from a person.

Your plan to refuse the upped dosage totally makes sense. This has worked for you a long time - why up the dose? You aren't having an increase of issues that warrants it. I have switched providers for trying to up my dose when not necessary - ran and never looked back.
Thank you for this. It is very helpful to hear another's point of view. I take the immediate release, not the extended release. Part of me wondered that if the doc made a big deal about making some change if moving to extended at the same dosage might help with his concern of the number of test result.

What is frustrating is that I've had this doc for a long time, so he knows the issues I've gone through with medications in the past and how stable I've been the past decade. I'd hate to change doctors, but I think if they push this on me, I may have to do so. I wish I could be sure to find someone like you mentioned where your neurologist was interested in finding out what level WORKED FOR YOU instead of just adhering to a reference range because that is what is printed in the lab documentation.
3 blood tests in 12 years doesn’t give your Dr much to work with. I hate increasing meds as much as the next guy.
I told my Dr once you’re just guessing!! “Educated guess” he replied.
Maybe hold off and get another blood test in a month or so.
Just an opinion ✌️
With most seizure meds there's a recommended range, but plenty of people can have control on either side of that range. That was my experience with Dilantin as well as with Lamictal. So-called "sub-therapuetic” levels are enough to give me seizure control.
I left email and voice messages for the doc, and his Nurse Practitioner finally called me back. She said that he agreed that different ranges are used, but the ranges for Keppra are best thought of on a bell curve. They said the understood my concerns and did not think there is any pressing or emergent need to raise the levels, but if there were a perfect storm of triggers, they wanted to protect me from a breakthrough. They agreed to let me think about it and decide if there was a better time schedule wise to try and raise it. But, at minimum they wanted to be sure they were giving me their recommendations.

We agree to do another test in a few weeks, as he said levels can fluctuate 20% even in the same sample.
Top Bottom