Can you have multiple sclerosis and not have lesions on your brain?

Here is My Question:
Can you have MS and not have lesions in your brain? I was diagnosed 16 years ago after years of being called "suspect MS". I had oligoclonal bands present in my CSF, documented by an Opthalmologist - Optic Neuritis, numerous symptoms and was diagnosed as having RRMS. After a number of IV steroid 'pulse therapy' sessions I was started on DMT's in 2001. I have had 3 major relapses since and a number of smaller ones. My neurologist died and I inherited a new one who says I can't have MS if I don't have lesions in my brain. I am very confused and scared.

Answer:
While it is certainly rare to see individuals with MS who have normal MRI scans of the brain, especially after many years, it still occurs. Whether or not your MS is at all similar to typical cases of MS is another question altogether. One condition that should always be excluded is neuromyelitis optics, also called Devic’s disease. This condition used to be considered a subtype of MS but is now considered an entirely different disease. Devic’s disease often involves only the spinal cord and optic nerves, and may worsen if you are treated with an interferon. There are other possibilities as well and you should work with your neurologist to sort out these diagnostic issues. If required, you may need to travel to an academic MS center for another opinion.

Revere (Rip) Kinkel MD
Director of the Multiple Sclerosis Program
Professor of Clinical Neurosciences
University of California San Diego