Went to the neurologist today

centralnjgal said...
I've only did a brain mri.. He wants me to do c-spine mri, just to get the whole picture. He wants me to come back for an EEG, VER and a lower SSEP test...Can anyone shed any light on what these tests are set up to test for?

If I still have symptoms that don't get better and the mri is negative, he said we could do a spinal tap..

He won't diagnose me with MS unless he says he sees something on an MRI.

He thought it wasn't too soon that I did the MRI of the brain since I had symptoms eventhough the symptoms I had were only for a few weeks.

Is he doing things in the right order?

Eleanor

The EEG, VER and SSEP all test nerve transmissions in your body, and depending on the results, will indicate whether you have a problem with the peripheral nervous system (things like carpal tunnel syndrome, or a pinched nerve in the neck, are problems with the peripheral nervous system. MS is of course a problem with the central nervous system).  The spinal MRI is done to see if there are lesions on the spine (sometimes they'll show up there before they show up on the brain), or other spinal problems that could be causing your symptoms.  The spinal tap is usually done last, mainly because it is so invasive, and there are sometimes painful side effects (a really ugly headache, fixable only by yet another invasive procedure). 

It sounds like he is being thorough, and testing for all the usual 'culprits' that can cause MS-like symptoms, if not MS itself.

Hi Eleanor,

    Wow sounds like your doctor is being very thorough.  All the tests he is performing are those commonly ran if MS is suspected.  The spinal tap is usually the last one ran as it's not always necessary if enough information is found on the other tests.  It's a very evasive procedure compared to the others.

Here's some more infomation on the tests:

EEG                http://www.nlm.nih.gov/medlineplus/ency/article/003931.htm

VER and SSEP  http://www.webmd.com/multiple-sclerosis/Evoked-potential-test-for-multiple-sclerosis

centralnjgal said...

Kimber..

You are a doll for being so responsive to me.. Thank you.. From what I hear about a spinal tap, I would be scared to death to get one from the side effects that people experience. I hope it doesn't come to that..

Eleanor

Many of us have had spinal taps *without any negative side effects*.  It is an invasive procedure -- the doctor is extracting spinal fluid from your spinal column.  Sometimes -- not always -- in fact, not MOST of the time -- some people experience a really bad headache after the tap is done.  The procedure to fix that is to return to the doctor, have him draw blood from your arm (like any other ordinary blood draw), and inject it into your spinal column, near the spot where the tap was done.  Almost instantly the headache is gone.

But again...MANY of us have had the spinal tap (or lumbar puncture...same test, different name) without ANY complications.  Usually the doctor will tell you to drink plenty of fluids before the test is done, and usually caffienated fluids (coffee, Coke, etc.). And then once the test is over, to lie FLAT for several hours, to give your body fluids time to readjust to the absence of the fluids drawn for the test.  Usually then you go about your business, with many only a slight backache the next day.

The test is really valuable, especially if all the other tests come back "negative", or "inconclusive", and you're still dealing with symptoms.  While the test in itself cannot diagnose MS, it CAN sometimes point to it, or to other things that might be going on in your central nervous system, like a bacterial infection (like Lyme) or chronic infection, or other disease mechanisms. 

If I were grappling with unexplained symptoms, and other tests have come back without any answers provided, and the doctor ordered a spinal tap -- I'd do it.  I've had 3 done over the years (for different reasons; the first to diagnose MS, as MRI's were not available then), and have never suffered any side effects except a back ache the next day.  After the first one, in fact, I got up off the table, got dressed, and went back to work...didn't know I wasn't supposed to...and had no ill effects at all.

By "invasive procedure" I mean a procedure that takes something from your body -- fluids, blood, etc.  The other tests are "external" -- you might have electrodes attached to your body, or endure being slid into the MRI tube - -but you leave the office with all the "stuff" inside that was there when you came in.  Doctors don't like to do invasive procedures unless there is no other way to try to figure out what is ailing a patient.  If all the other tests come back negative, or inconclusive, indeed a spinal tap might provide answers, or at least a direction, that the other tests didn't offer.

centralnjgal said...
Uppity,
Again, you are great when it comes to explaining things. The neurologist I went to is a Board certified neurologist, but has only been board certified for several years. If it comes down to a spinal tap, shouldn't I go to someone who specializes in MS and someone with more years of experience under his belt practicing to play it safe??

Eleanor

If the doctor does recommend a spinal tap, you can always ask how many he's done, and share with him your fears.  He'll likely be able to alleviate those fears, and even sometimes they'll prescribe a mild sedative so you aren't so anxious when the procedure is done.  So if you like your neuro, and he says he'll do it, I'd let him do it.

MS, by the way, is one of the more common neurological problems, and many neuros see lots of MS patients every day, in their practice.  This is another question you can ask your current neuro -- how many of his patients have MS? 

I, by the way, haven't been to a neuro for anything for years, now. My family practice doctor (who's speciality is "women and children", but she's my doctor and my husband's doctor) takes care of anything and everything related to my MS.  She has several patients in her practice with MS; she takes care of all of them, with only occasional consults with a neuro.