Can you have MS with no signs of it in a lumbar puncture?

Here is My Question:
Various doctors have suggested I have MS, 3 times over past 17 yrs, due to having most symptoms, no other causes, even MS lesions on my MRI. However, my lumbar puncture was clear a few yrs ago. HLA-B27 positive also. Since lumbar was clear, they said not MS. But fail to be able to give me another Dx. So I'm stuck in limbo with no meds.

Answer:
Can you have MS with no signs of it in a lumbar puncture? Approximately 5-10% of patients with MS will have normal spinal fluid. The test can be helpful to confirm "dissemination in time" which is part of the McDonald diagnostic criteria for MS (which you can read about on this site). Since your spinal fluid doesn't support that part of the criteria, the other way to confirm "time" is by your history and a careful neurologic examination. Another aspect of the diagnostic criteria is to rule out mimickers of MS. Sometimes, an HLA-B27+ result can indicate Neuro Behcets disease (but only in the appropriate clinical setting and confirmed by the neurologist). 

In my opinion, it is best to get additional opinions from fellowship trained neurologist in MS (also known as a neuroimmunology fellowship). This training provides additional experience in differentiating mimickers; although, sometimes, the diagnosis is elusive.

A. Scott Nielsen MD MMSc
Neurologist and MS Specialist at Kaiser Permanente