I’m not surprised you’re confused!
One of the classic features of MS is “clinically silent” lesions - in other words, lesions that don’t cause observable symptoms. (This is why someone might initially present with only one symptom, but have lesions all over the place.) So, while it’s probably not common, it could be that you have been lucky in that your new lesions haven’t arisen in any “important” area. BUT, having any new lesion means that your MS is active and that means that there is every chance that the next new lesion will happen somewhere important.
If you have RRMS and were currently on a DMD, and assuming that your last MRI wasn’t years ago, then 5 new lesions would be considered a treatment failure by any standard. In normal circumstances that should mean a change of DMD. If you were on a first-line injectable DMD, those lesions or just the two active lesions would mean that you were eligible for Tysabri. (Remember also that you only need 2 lesions to be diagnosed with MS!)
If you have RRMS and were not on a DMD (and not on a trial), I would have thought that those 5 lesions would be more than enough to get you onto a DMD.
I keep thinking of the McDonald criteria for diagnosing MS. They state that dissemination in time can be demonstrated by a new lesion on MRI - there is absolutely no mention of symptoms or relapses. Perhaps they thought this implicit, but perhaps they were also accounting for silent lesions. I really don’t know. But dissemination in time means separation of attacks in time. So, if a new lesion indicates dissemination in time, it also means a relapse. (Btw, 5 new lesions of which 2 are enhancing means at least two attacks.)
I guess it all comes down to whether or not you are RRMS. I just found this website which confirms my (sometimes shakey!) recollection that a feature of SPMS is a lack of new lesions: Multiple Sclerosis So, the fact that you have new lesions (especially that you have enhancing lesions) strongly suggests that you still have RRMS. And that your RRMS is active.
So why is the neuro not getting out the prescription pad? Well I certainly don’t understand why not! Two obvious questions: is your neuro an MS specialist? can your neuro actually prescribe DMDs (some can’t, but keep it quiet!)?
Of course, I’m not a neuro so there could well be things that I don’t understand, perhaps about the trial you were on, the drug you were on, local PCT rules, budgets, and probably a load of other things. Perhaps his refusal is simply down to the NICE criterion that to get DMDs that you have to have had “two clinically significant relapses in the last two years”. If that is the reason, then he could at least be upfront about it! And, ideally, be flexible: five new lesions is not a small amount of activity. Knowing that your MS is active means knowing that you could have a disabling relapse any day. His job is to keep you as healthy as possible. Surely that means prescribing the best preventative meds that he can?
Not sure this gets you anywhere(!), but I hope it helped a bit.