When possible, a physical examination should be performed immediately after an attack, aimed at identifying signs of injury, cyanosis, cardiac rhythm abnormalities, acute motor deficits, and the level of consciousness. The presence of bruises, tongue or other oral lesions, as well as of prolonged stupor or obtundation suggests that the seizure was indeed epileptic and generalized. Vital signs and cardiac rhythm should be checked. Any focal motor or sensory deficits or aphasia should be noted, because these may represent acute postictal phenomena with significant localizing value (see below).
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