Anyone newly presenting with such cns lesions should be tested and restested for Lyme disease, and frankly if they live in New England or anywhere Lyme disease is prevalent i would say they ought to be proactively and preliminarily treated with doxycyline or minocycline for many weeks (or some standard good anti-Lyme treatment) before assuming this is MS and going down a road that presumes no decent end point. Lyme is treatable and often curable and can and does present like MS very very frequently, but because of the largely politicized medical climate surrounding its treatment, too many are not treated adequately or have been ignored or are now being consigned, i fear, to the MS basket. But MS is a diagnosis largely of whatever it must be if we cannot diagnose anything else...and we can diagnose Lyme disease, if we try hard enough, and not just through the limited assays of the ELISA or western blot, which are notoriously inaccurate in the sense of providing a huge number of false negatives...This is one case where using antibiotics even when uncertain of the absolute need for them might in fact be justified in order to save patients from lifelong disability and even deterioration and death.