“I had a seizure but I’ve started my tablets again — I can keep driving, can’t I? I need my car for work”

A breakthrough seizure after missed medication is both a clinical and a professional consultation. Clinically, explore WHY the medication was missed (busy/forgot, ran out/supply problems, beliefs such as "felt fine", side-effects, cost, chaotic routine) non-judgementally, reinforce that anti-seizure medication must be taken consistently and that abruptly stopping can precipitate seizures (rarely status), and problem-solve adherence (reminders, repeat prescriptions, pharmacy ordering); review seizure type/control/triggers and any injury, consider neurology review/optimisation, and sensitively screen mood and SUDEP/safety awareness. The critical professional/safety duty is DRIVING: after a seizure there is a LEGAL obligation to inform the DVLA and the patient MUST STOP DRIVING — restarting tablets does not change this. The broad rules: Group 1 (car/motorcycle) generally requires a seizure-free period before relicensing (DVLA Assessing fitness to drive, November 2025 edition: 12 months free of any seizure for established epilepsy — the 6-month period applies only after a first unprovoked seizure, and the medication-change route only when the change was on medical advice), while Group 2 (HGV/bus) requires 10 years seizure-free without medication; the exact period is set by DVLA criteria, but the immediate message is stop now and notify, framing that good control and meeting the criteria are the route back to driving. The doctor’s duty is to ADVISE this clearly, explain why, and DOCUMENT it; it is the patient’s legal responsibility to notify and stop, but per GMC Confidentiality: patients’ fitness to drive (2017), if a patient continues to drive against advice and cannot be persuaded, the doctor should make every effort and then contact the DVLA promptly (telling the patient first and confirming in writing afterwards) — confidentiality yielding to public safety. The hidden agenda is fear for his livelihood plus minimisation; be empathetic about the job impact, fix adherence supportively, signpost work/practical support (fit note with amended duties; Access to Work travel funding), and be honest about the driving duty WITHOUT colluding.