When is A Typical a wrong diagnosis? In November 2013 I had multiple thoracic lesions, plus one TH8-11, and one @ C5 with no optical neuritis. Negative O Bands x 2, negative bloodwork lupus, lyme, NMO, sjogrens, etc...absolutely perfect levels of everything. I was passed from one doctor to another with no treatment for a year. Then in July 2014 I had another MRI enhancing lesion TH7. I was told it was Transverse Myelitis, that the TH7 was a "Picking" of an old lesion, not active disease. It has been 7 months between my first and second MRI, plus new lesions, plus relapses or worsening of symptoms, but no diagnosis and no treatment...Why the reluctance to treat it as MS?
There are many conditions that can cause relapsing myelitis with multiple T2 and gad enhancing lesions at multiple levels in the spinal cord, a normal MRI of the head and no oligoclonal bands. This includes autoimmune myelitis associated with aquaporin-4 or collapsin response-mediator protein-5 [CRMP-5] immunoglobulin [Ig]Gs, or idiopathic recurrent transverse myelitis. Treatment usually is different from standard MS disease modifying therapies and includes, intermittent steroids, sometimes plasma exchange, rituximab, azathioprine and mycophenolate.
Discuss alternative diagnoses with your current neurologist and see if you can isolate the most likely diagnosis and initiate appropriate treatment. A second opinion with an MS specialist or Clinical neuroimmunologist may help.
Revere (Rip) Kinkel MD
Director of the Multiple Sclerosis Program
Professor of Clinical Neurosciences
University of California San Diego