Is a lumbar Puncture *really* necessary for dx?

[thisiswater]

My neurologist wants to do a LP. Is this *really* necessary. He thinks I have MS due to optic neuritis 7 years ago and a recent MRI that showed more lesions.

[lyndacarol]

My neurologist wants to do a LP. Is this *really* necessary. He thinks I have MS due to optic neuritis 7 years ago and a recent MRI that showed more lesions.

Welcome to ThisIsMS, thisiswater.

Based only on my symptoms and my 4th MRI (which finally showed lesions), my neurologist made the diagnosis of MS for me. I never had a lumbar puncture (LP). It is my understanding that a lumbar puncture is not necessary to make the MS diagnosis, and is used less often these days with the availability of MRIs.

[thisiswater]

I think he may want to do it because my lesions don't present in the typical MS pattern. Would that make sense?

[euphoniaa]

I think he may want to do it because my lesions don't present in the typical MS pattern. Would that make sense?

Hi and welcome!

Yes, it's likely that he wants to add the LP to the evidence, but a positive LP result can indicate many other things besides MS. My own doctors (13 yrs ago) seemed to think an LP was the most definitive test for MS and important to lock in my diagnosis (although my brain MRIs alone made them "almost 100%" sure). However, I've since found out that there is no single MS test -- it should be a process of accumulating evidence.

Considering that an LP is stressful & often leads to pain afterwards (I had no problem whatsoever with mine, tho) many docs won't insist on it these days.

Good health to you!

[scsi]

I think it's s standart protocol for complete dx, not necessarily it will show oligoclonal bands in csf, but you could have ms anyway.

I've got it twice and, oh man, it was horrible.

[1eye]

I never had one. I think that with the so-called McDonald criteria (time and space) they are waiting for more than one clinical happening. In my case it was 2 MRIs over more than a year. I have not yet read the next thread, which claims only MRI is necessary, so things might change.

[scsi]

so things might change.

hope so!

[kw202]

I posted a response to you on another board so I won't repeat everything I said there, here - but in short, my experience with a puncture wasn't awful. There were a million things I'd have rather done, but it was fine. My puncture was the last piece needed to make my diagnosis.

It wasn't very painful, beyond the lidocaine shot which really wasn't bad. After that it wasn't even particularly uncomfortable. Just annoying. My back was sore for a few days after, but it was manageable and sort of expected considering.

I didn't get the spinal headache. Just make sure your doctor uses a less-traumatic "sprotte" needle, and lie flat for a couple of days.

I read my report later and the doctor wrote that I "tolerated the procedure well." I had a moment where I felt like I needed to get that framed and hang it next to my degree or something.

If it's recommended, don't be afraid to get it. Some people do get the headache, and that's a pretty terrible side effect - but most people don't, especially if they are able to use the sprotte. Most people build it up worse than what it typically is (I sure did).

[1eye]

After reading the paper yesterday posted in the thread http://www.thisisms.com/forum/general-d ... 27269.html by frodo, called Quantified CSF antibody reactivity against myelin in multiple sclerosis, I am convinced that there is now an inexpensive test for Multiple Sclerosis, that does not even involve MRI. If some enterprising doctor would start using this (without charging thousands of times the cost), the world would beat a path to their door. I think in most cases MS patients should be paid to undergo the old, normal CSF tap, now that drug manufacturers know they can use CSF from MS patients in MS animal models. But in fact it sounds as if only a tiny amount of CSF is necessary to make the diagnosis of Multiple Sclerosis.