MS Diagnosis

Question:
​My first attack was 2012, pins/needles, numbness, altered sensations, muscle cramps, fatigue. MRI showed multiple lesions but CSF oligoclonal bands -ve and VEPs -ve. Because attack lasted so long, was also tested for lyme, CADASIL and MERRF? 2017 it is back with all old symptoms plus brief (30min) paralysis in arm, shaky legs and leg jerking. LP was bad experience with severe headache and vomiting for 4 days whenever I tried to get up, do NOT want it repeated! Do these bands show up later, is 5yrs long enough? Will a new lesion on brain MRI be sufficient for diagnosis without LP again? Thanks

Answer:
A definite diagnosis of MS requires characteristic syndromes (not just symptoms) and characteristic findings on examination supported by MRI findings and sometimes CSF findings; Over 98 % of definite MS cases have characteristic MRI findings and over 90 % have characteristic CSF findings. Characteristic new lesions on MRI in the correct clinical setting supports the diagnosis. CSF findings may be negative at onset but usually positive with continued disease activity over 5 years.

Headaches after spinal taps (also called lumbar punctures) can be avoided if the doctor uses a small (22-25 gauge), atraumatic spinal needle . Unfortunately few doctors have learned how to use these special needles.
Good luck

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