Living with MS: No Evidence of Demyelination

Patient Expert

People who are in the process of being tested for multiple sclerosis often have many questions. Some of the most common questions surround the subjects of MRIs and lesions. Magnetic Resonance Imaging (MRI) is a powerful tool used to help diagnosis MS as well as measure disease progression. Lesions are the scars caused by demyelination which can be detected by MRI scan.

There have been many occasions where people in the process of being diagnosed with MS ask whether it is possible to have MS and not have brain lesions. The short answer is an unequivocal YES.

When I first experienced blinding optic neuritis in 2000, the neurologist ordered MRI scans of my brain. The results showed inflammation of the optic nerve, but no detectable lesions in the brain. Thus I was not diagnosed with MS at that time.

Five years later, when I was undergoing MRI testing of both my brain and cervical spine, lesions were seen in my neck. But my brain was still clear from lesions or atrophy. We only had to wait a few months until additional lesions showed up in my cervical spine and an official diagnosis was made.

Eventually the smaller lesions in my spine grew together to form one large lesion that spanned from the C4 to C6 vertebras. At the time I switched from my original disease-modifying therapy (Copaxone) to a totally different treatment approach (off-label Rituxan), I was hoping to avoid developing even larger lesions in my spine as I was definitely experiencing increased symptoms and relapses.

After I had been on Rituxan for a year, my MRI report indicated stability in lesion load, meaning that I had not developed any new or larger lesions. Follow-up scans two years later were stable, without evidence of new or worsening lesions, once again.

Another two years have past and I've just recently undergone MRI exam to determine two things: 1) How is my MS is doing? and 2) Is my current treatment continuing to be effective? What follows are the radiologist's reports following the recent MRIs.

I'm sharing these with you today to demonstrate that even several years after diagnosis, it is still possible to have MS without evidence of demyelination in an area of the central nervous system, such as the brain. I still experience MS symptoms which predictably get worse under certain circumstances, but my MS is rather stable. And the best news is that my previously massive lesion has gotten considerably smaller.

Brain MRI, MS Protocol, 12/3/14:

  • Comments: MRI of the brain was performed with and without contrast enhancement on a 3 Tesla magnet. Enhanced images were obtained following intravenous administration 10cc Gadavist.
  • The cerebral ventricles, cortical sulci, basilar cisterns are normal. There are no signal abnormalities in the brain parenchyma. There is no infarct, mass, hemorrhage, or enhancing lesion. There is no evidence of demyelinating disease. The appearance of the brain is unchanged compared with 12/19/12 MRI.

  • Impression: Normal MRI appearance of the brain.

Cervical Spine MRI, MS Protocol, 12/3/14:

  • Comments: MRI of the cervical spine was performed with and without contrast enhancement on a 3 Tesla magnet. Comparison is made with prior cervical spine MRI from 12/19/12.

  • Vertebral body alignment is normal. There is no concerning focal marrow lesion. There is a small region of abnormal T2 prolongation in the left ventral aspect of the cord at the C5 level. This is in keeping with old insult such as demyelination. There is no new or enhancing lesion.

  • There is mild disc disease. There is mild disc bulging at C5-C6. There is small right paracentral disc protrusion at C6-C7. The disc protrusion at C6-C7 is slightly more prominent. The central canal and neural foramina are adequately patent.

  • Impression: Stable left ventral cord signal abnormality at C5 in keeping with old insult such as demyelination. No new or enhancing lesion. Mild disc disease.

As I shared on Facebook, "I like boring bottom lines." Same-o same-o is a very good thing when it comes to MS. I am fortunate to be one of the few people with MS who respond to treatment and whose disease has become stable over the years. I am blessed. Whoohoo