Keppra

Yes the MD does need to know about seizure activity; especially after a medication change. How is else is he supposed to know if further adjustments need to be made? One day without seizures doesn't mean stop the meds. Rather it means the meds are probably working.

If there was a rule that an MD needed to know about "ALL" seizure activity, some people would be calling their doctors hundreds of times a day. And no, that's not an exaggeration. My background is inpatient neurology and by no means did we advise people to contact the MD about all seizure activity. Every patient has a different baseline. Before I had my brain surgery, I had seizures every day and I never called my neurologist unless they were bad enough to send me to the ER. So with probably thousands of seizures in my life time, I called my doctor about it maybe three times. In the case described in the OP, if it's known that he typically has seizures when changing environments then I wouldn't have called the MD when he had a seizure exacerbated by changing environments.

Did they bother to check levels at all before increasing the dose? And WHY is a PCP managing the patient's anti-epileptics? That should be up to the neurologist. Keppra is typically not given TID and my guess would be that it's likely that the patient wasn't on a therapeutic dose.