As Snoopy said there are certain criteria to get the diagnosis and a litany of conditions that can mimic MS. Yes your neuro is correct that sometimes it just takes a bit for it to show in the imaging, and while o-bands are fairly definitive if you have them in the range, just because you don’t doesn’t mean it’s not MS.

For my own diagnosis it was pretty much a process of elimination, yes I have hemochromatosis anemia which could explain some of my symptoms but not all of them and it’s well managed and lacking in organ involvement to have degraded to the physical and mental impairments, it could have been a brain tumor, but given the length of time for symptoms and progression it was slow growing but the parts impaired would have made it at the time inoperable. Since I didn’t have insurance at the time and copaxone was still super expensive experimental medication, it was a wait and see game. If I was still alive after 6 months and not further progressing woohoo not a brain tumor .

It could have been MD, also not much that could be done for it, but an odd ball case since if it was childhood MD I was progressing very very slowly, and if it was adult onset I was super young at the time to have it It also could have been ALS which once more nothing could be done, sooooo... treat the symptoms and hope it’s not! Or what my doctor was really betting on if he had to pick was MS. It was another 10 years before I had insurance and could get the testing done and then it was wham bam congrats you have MS . MRI showed the lesions, and spinal tap showed the o-bands and it was in the range. So it was really easy, and by then copaxone was out, covered by most all major insurance and had a co-pay assist plan.

So I’m not really sure how it would have worked if I had started the process 10 years earlier, or better still if my parents and pediatrician had started the diagnostic procedures even before then since throughout childhood I had many of the same symptoms as now just they get worse, sometimes a little better and then worse again, oh the joys of rrms