Brief Answer:
CT scan and neurologist consult regarding arm weakness

Detailed Answer:
Dear XXXX,

Thank you for trusting us in HCM with your query. I will answer your question to the best of my knowledge.

First dizziness and balance problems are common in your age and they require special attention from your side since falling might lead to bad outcome. Its important to understand that keeping a balance is a complicated orchestrated phenomenon that the our bodies do without us being aware of but this require intact vision, intact vestibular system (ear), intact touch and feedback from our muscles to our brains and intact joints.

Dizziness might indicate a serious problem in the case of weakness sensation in the arms or the legs, please refer to your neurologist as soon as you get those attacks again and ask for a CT scan since they are more sensitive to role out stroke or hemorrhage in acute states than MRI.

It is great that you took your symptoms seriously and you did seek medical attention from a neurologist and and ENT specialist those two specialties will know and provide the best assessment of your case. Glad to hear that no signs of Stroke or any brain abnormalities were found in your MRIs. I have to disagree with your neurologist a diagnosis of a seizure is not probably what is going on for 2 reasons first no EEG changes but since probably EEG was not done during the attack you might want to repeat the EEG while the attack is there, second thing that the drug is not helping you, but I do understand why your neurologist thought of seizures. After doing the CT and once results are negative for stroke refer to an ENT and ask for vertigo test to be done he or she will be able to prescribe medication for vertigo which might help, moreover ask for a fasting glucose level, and accumulative blood sugar test to role out diabetes. I would suggest heart monitoring but you already did that and results were negative which is great.

What I can advise is that you make sure whenever you feel dizzy to set it is very important that you do not fall, in your age feeling dizzy and falling afterwards is very common but please be careful.

Do you happen to get headaches during the attack? do you hear noise (tinnitus) or any hearing problems usually or during the attacks? do you feel that standing after laying down might lead to this feeling of dizziness? do you take any medication other than Keppra currently? do you have any chronic illnesses?

Feel free to answer those questions which will help narrow down the diagnosis. Feel free to send me any reports too.

I hope this was helpful. Stay safe.

Kind regards,
Dr. Nazzal

---