Can it ever be ruled out?

[Deb]

For the past four years, I have been experiencing a variety of sporadic symptoms including migraines, neuralgias(limbs and facial), numbness, tingling, blurred vision, cognitive problems,etc... -a familiar list, I'm sure.  The most recent addition to this list is bowel incontinence, which has now ceased for 2 months.  I've had both brain and cervical/thoracic MRIs within the past year, both negative except for a slight disc bulge in C5-6, and 2 years ago, sensory and visual evoked potentials(negative).  Drs noted absent "wink" reflex and decreased muscle tone.  Other than this, neurologic exam has been normal.  At what point can MS finally be ruled out as a cause for these symptoms?

[Deb]

Thank you for your reply.  I am relieved to hear that MS is unlikely!  I have not, however, had CSF analysis.  Would this be helpful, or not really necessary?

[CCF Neuro[P] MD, RPS]

Dear Deb:

With the normal MRIs of your brain and spine, without any CSF findings of oligoclonal bands, IgG synthesis, and loss of tone and not increased tone, it is doubtful that you have MS.  MS is due to demyelination of central axons and subsequent axonal damage.  This should give areas of demyelination, muscle weakness but spasticity or increased tone.  Your symptoms and MRI do not fit the picture.  So, I would think that at this point MS is not in the differential of possible etiologies.

Sincerely,

CCF Neuro MD