Should I get a spinal tap?

Here is My Question:
Lumbar Puncture After CIS

I had an episode of what appears to be optic neuritis just over a year ago. I have a few brain lesions (small, non-specific) as well.

My neurologist is an MS Specialist and she’s really encouraging me to have a spinal tap. My question is: How likely is a spinal tap to be positive after a clinically isolated event? I do have symptoms dating back a few years but if they’re not due to MS and the optic neuritis was truly the first event is the lumbar puncture worth the risk this early on?

Answer:
The lumbar puncture can now assist in making the diagnosis of multiple sclerosis sooner.

It can be especially helpful if the MRI results were equivocal and the diagnosis is still unclear (90% of patients with multiple sclerosis will have oligoclonal bands in the spinal fluid).

So, if your spinal tap shows no oligoclonal bands it makes it less likely you are going to go on and develop MS; if however your spinal fluid does show oligoclonal bands, that is another piece of information supporting the diagnosis of MS.

The results of the spinal tap may aid you and your neurologist in making the decision as to whether you should start disease modifying therapy (DMT) for MS.

Benjamin Osborne, MD
Associate Professor of Neurology and Ophthalmology
Director, Neuromyelitis Optica (NMO) and Neuro-Ophthalmology Clinics
Associate Director of the NIH/Georgetown Neurology Residency Program
Medstar Georgetown University Hospital