3 year old patient presents with seizure like symptoms. abnormal bilateral upward vertical eye movement, irrational behavior, loss of balance, slurred speech, confusion. brain mri normal, bloodwork normal, cant get eeg. what could this be?

It is reassuring that the brain structures appear normal. The EEG and a Pediatric Neurologist should further evaluate. Maintenance of hydration and avoid fever. Toxic exposure, including drugs and lead level should be ruled out. Please follow up with a specialist.

Your description does suggest epilepsy, and it is appropriate to see a pediatric neurologist. Not clear to me what prevents an EEG, as this could be very confirmatory. A trial of anti-epileptic medication might be helpful.