can MS be diagnosed solely by lesions on the brain?

i am thinking a lot today....probably too much.  as you likely know if you read my posts, i have several small lesions on my brain (less than 10).  (are lesions the same as "small non-specific white matter spots"?) after finding no evidence of MS in any bloodwork, cervical/spinal MRI or a neuropsych evaluation my neuro said she wanted to take the wait and see approach.  i didn't agree so we are going forward with evoked potential and lumbar puncture.  if both of these tests also do not point to MS what do i have left in terms of testing?  i will definitely be seeing a new neuro but are there other tests to perform to either rule it in or rule it out?

my symptoms are fuzzy vision/squinting (a lot when i work on a computer), i often stare into space (i am alert and aware that i am staring but i just stare), some memory loss though this seems to have subsided, and some days i just don't feel right in my skin (about 1 day per week).  she said my symptoms aren't really severe enough or specific enough to diagnosis MS.

thanks
r

[HVAC]

There are lots of blood tests to rule out other diseases. MS mimics. The wait and see is standard. Mine was two years of testing. Six months apart.

[babyatlas]

HVAC,
i had a bunch of bloodwork done and they found nothing else.
the thing that bothers me about the 'wait and see' approach is that it is my understanding that there are lots of good treatment options that slow the progression and i would HATE to miss out on being treated while we wait and see if other symptoms develop.
i am beginning to understand why people hate limboland and often find relief in having a diagnosis of MS....not that they want MS but they want an answer and to close the door on the questions and start the treatment.
thanks
r

[samandsprout]

You sound EXACTLY like I did several months ago.  I had been in limboland for 6 years with only minor symptoms but with lesions on brain MRI.  Normal LP, VEP, normal neuro exam, normal blood work.  My symptoms and my neuro exam just didn't match the MS diagnosis.  All I could do in the beginning was "wait and see".  

And this bothered me for exactly the same reasons it bothers you, and rightly so!  

I went about my life, had 2 kids, and had 2 more MRIs along the way.  There was some confusion as to whether the MRIs were stable or not.  They said no new lesions, but 2 lesions "may" look larger.  I had another VEP, normal again. I had a cervical spine MRI that was normal (although on the unreliable 1.5T).  

6 years after my first MRI, my neuro still didn't see clinical evidence of MS.  I should point out that my lesions are not in the typical location for MS (but that doesn't mean it's not MS, it just may be atpyical).  

So, I could have continued waiting, but I decided to go for a 2nd opinion, thanks to the recommendations from this group.  The 2nd opinion neuro saw something different enough on the MRI films to diagnose me with Clinically Isolated Syndrome, which qualifies me to start a DMD.  Relief!  She has also ordered some additional tests that could help determine if this is early MS: a somatosensory evoked potential, and auditory brain stem evoked potential, and a thoracic spine MRI.  

So, I did have to "wait and see" for at least some time to pass to see whether my MRI changed.  But I also had to stay on top of it myself and I just keep pushing to get all the tests that I can, to gather all the evidence that I can.  You are doing the right thing by getting the tests done.  Maybe something will point to MS, or maybe not.  But you have the right to get to the bottom of what is causing your lesions and symptoms.  

My 2nd opinion UCLA neuro told me that they are scanning a lot more people than they used to, and that more and more people are showing up with these unexplained non-specific lesions, and it is kind of causing them some problems.  She even told me if I had come to her first, she probably wouldn't have even done an MRI on me with the minor sensory symptoms that I had.  When the clinical picture hasn't caught up with what's showing on the MRI, it puts them in a tricky spot.   They need more evidence.  Dissemination in time and space...that's why sometimes we have to "wait and see".  But in the mean time, just keep pursuing the testing.

[Deb61]

Sometimes the neuro doesn't have all the information to make a diagnosis because other factors can cause brain lesions that are seen on the MRI.  The answer to the question as to whether or not MS can be diagnosed with just a brain MRI, is a complicated one.  Sometimes findings on the MRI show lesions that correlate with MS type lesions (where the lesions are located, size, shape, etc.).  Combine that with clinical information, history information, and other data, your neuro will feel confident that it is MS.  Listening to other people about how they were diagnosed, this may not be the norm.

If your neuro wants to use the wait and see approach, he/she is probably looking for evidence of a second attack or needs other data to help with the diagnosis.  Blood work won't rule out all of the mimics (which can be equally bad or worse).  There are many causes of neurological problems that won't show up in blood work.  

If the LP and EVP tests are negative, your doctor may use the wait and see approach and use future MRIs to show evidence or growth of old lesions and/or new lesions.  I was diagnosed after the second MRI six months later, and when I was exhibiting signs of an attack.

Deb

[babyatlas]

samandsprout-
WOW!!  thanks so much for your post!  i am sorry for all you have had to go through but it gives me hope and the perseverence to push forward.  can i ask what your early symptoms were?  have you developed more symptoms over the course of 6 years?  did your symptoms receed during pregnancy with your 2 children?  i ask this because 6 years ago i went in with symptoms and had a brain MRI.  the MRI was clear and i found out days later that i was pregnant so the doctor chalked it all up to pregnancy and that was the end of it.  i have read that MS (or like) symptoms tend to go into remission during pregnancy.  my youngest is now 2.5 and my symptoms started noticeable 6 months ago BUT i was having trouble with my vision over a year ago so it could have been when my youngest was about 1 years old.


Deb - thank you also for your insight.  i hate to wait (as i know you all do) but that may be the route i am on.  i will do the VEP and LP and see what is discovered.  if my doctor is uncertain i will move onto a new neuro...she is not the friendliest person you'll ever meet anyway :)