Do you titrate anti-seizure medication doses in the setting of high or low serum drug levels if patients remain seizure free?

The short answer is "no", especially in the setting of high levels, if there are no side effects reported, and other appropriate surveillance labs look good (such as CBC and LFTs for VPA). The only case where I might increase the dose slightly would be for a below-therapeutic range level in a seizur...

I fully agree with the above answers that we treat patients and not their numbers, and to be honest, I never check levels on the "newer" medications anyway, unless I am suspecting the patient is not taking the medication (it really has not happened). I have not increased lamotrigine even during preg...