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Can an MS diagnosis be made without lesions present on MRI?

Can a doctor can provide MS diagnosis based on symptoms without brain and spine lesion presence in MRI as per the new McDonald Criteria?

  1. An MS diagnosis still requires the same battery of tests including MRIs to detect the presence of lesions. You might be referring to one of the key changes in the 2017 update that reads:

    (Key changes for people with typical CIS)

    "CSF oligoclonal bands: Positive findings of O-bands in CSF can substitute for demonstration of dissemination of lesions in time in some settings."

    It seems to say that a person who has had one MS attack and diagnosed with CIS might not have to show a new lesion after time has elapsed if a lumbar puncture is positive for oligoclonal bands, in order to fulfill the criteria for an MS diagnosis.

    But that does not mean a positive lumbar puncture eliminates or replaces the need for brain and spine lesion as evidenced in MRIs.

    I'll run this by Dr. Aaron Boster for some professional input. Thanks for the question! Let's hope a medical professional chimes in here in the mean time. --Kim, moderator

    Here is a PDF of the 2017 changes via NMSS.

    1. Hi ! I want you to know that one of our advocates answered your question, but her comments got hung up in the system due to a glitch. One of our site managers will clear them in the morning, I am sure. Best wishes! - Lori (Team Member)

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