diagnosis questions

[sheilabmc]

i am undergoing testing, will have LP done soon. question: should i be pursuing any other diagnosis? (b-12 def, cervical disc, etc)
i have twitching,tingling, numbness that comes and goes. l'hermittes that i only feel in legs,bladder(shock-type sensation when i tuck my chin)
diagnosed foot drop.(wear afo) fatigue in hot weather. extreme intolerance to heat and cold. i do not sweat. muscle spasms and tightness, especially in legs. episodes of buzzing in hands, lips. bladder frequency and urgency(no uti) bowel problems(no rectocele or ibs)
i have had 5 mri's: brain shows small periventricular lesions, one 5-7mm lesion that since has diasppeared. cervical mri shows small bulge at c6-7 that they say is not the cause of sx. thoracic mri perfect. b-12 levels 912.
i think i have ms. neuro won't commit, says he does not know.
i am getting desperate for a dx. i need to continue work, have disabled husband.
i'm female 49 (sx stated 4 years ago, shortly after rabies series) take nexium, detrol, premarin, synthroid(levels checked every 6 mo) zanaflex and aspirin for sx. good health otherwise, history of mild migraines(seldom now)
what should i do? could it be anything but ms? and should i wait for other signs to show? thanks.

[CCF-Neuro-M.D.-JT]

Extremely difficult if not impossible to comment on an MRI that I have never seen personally.  What I can say is that MS tends to affect the periventricular region of the brain.  Other diseases that can mimic MS on an MRI include migraines, little silent strokes especially if you have cardiac/stroke risk factors, lyme disease, vasculitis, sarcoids and lymphoma among other possibilities.  Although I can certainly understand your frustration and desparation in wanting a diagnosis one way or the other, your neurologist is probably being careful about making the diagnosis of MS so as not to commit to labeling you with a lifelong disease that currently has no cure.  

Your complex of symptoms certainly could represent MS.  Make sure the LP coming up will include an immune panel called Tourtellote's that looks for immune breakdown products in the spinal fluid.  This helps point to the diagnosis of MS.  Blood work to rule out autoimmune or rheumatological as well as infectious diseases (lyme) should also be considered.  Finally if everything turns out negative, and the MRI is normal you could consider an EMG to check out a peripheral cause for the numbness/tingling, muslce spasms, and foot drop. Good luck

[sheilabmc]

thanks for the reply.

i have had lots of bloodwork, we have ruled out lyme. i am not high risk for stroke/vasculitis (neuro is not seriously pursuing other testing-everything is geared toward ms)

migraines, i have had, but they have never been severe.

emg testing was inconclusive, except the peroneal nerve in l knee is showing abnormal signal. it, however, had improved the last neuro visit.

thanks.