Early treatment takes centre stage in MS care forum

Doctors have called for earlier recognition, faster referrals and better coordinated care for people with multiple sclerosis (MS), where more than 70 diagnosed cases are being tracked.

Physicians from Barbados and across the region met at the Hilton Hotel for a forum to examine how early diagnosis and prompt treatment can change the course of the long-term neurological condition. They were joined by a neurology researcher at a major MS treatment centre in the US.

Dr Daniel Ontaneda, a neurology professor and research director at the Cleveland Clinic Neurological Institute in Florida, outlined changes in the understanding, diagnosis and treatment of MS worldwide. He stressed the importance of bringing advanced approaches to Barbados to improve patients’ long-term outcomes.

Neurology Professor and Research Director at the Cleveland Clinic Neurological Institute Dr Daniel Ontaneda

Care should extend beyond medical symptoms to protect patients’ independence, employment and everyday quality of life.

Dr Ontaneda said: “We need to focus on patient ability rather than their disability and suggest work adaptations such as adjusting work hours, job roles to maintain employment, and anticipating the need for allied health services, and have local go-to professionals to whom we can refer.”

Early recognition and cooperation among health professionals were central to his message, along with healthy lifestyle changes and managing other medical conditions and complications.

“I think the main points I want to highlight are early recognition and referral for neurology assessment and workup, the essential role of multidisciplinary care, including the primary care physicians, all of the therapists, the other specialist physicians, and reinforcing good lifestyle habits and management of comorbidities and complications.”

The presentation focused on the evolution of diagnostic tests and guidelines, from early milestones to the updated 2024 McDonald criteria, the internationally used guidelines that help neurologists diagnose multiple sclerosis (MS). They combine symptoms, examinations, scans and other tests to identify characteristic damage to the central nervous system, while ruling out other possible causes.

Experts gathered at the Hilton Hotel for a forum on Multiple Sclerosis to help raise awareness and the importance of early diagnosis and treatment

The 2024 revision recognises the optic nerve as an additional site of damage and includes newer scan features and laboratory markers to help identify MS earlier and more accurately. Some laboratory tests still require fluid collected through a spinal tap; they do not replace the procedure itself.

Earlier diagnostic approaches required careful balancing to avoid misdiagnosis, Dr Ortaneda explained.

Data from the US and Latin America show that about one in five people previously told they had MS may have been misdiagnosed, often because normal blood vessel wear and tear in older adults or people with other illnesses was mistaken for the condition.

The 2024 guidelines introduce tools intended to improve diagnostic accuracy and identify the disease sooner. The optic nerve is now formally recognised as a fifth anatomical site that eye scans or nerve tests can assess.

The guidelines also introduce advanced imaging markers and laboratory tests, including specific blood vessel signs on magnetic resonance imaging (MRI) scans and newer laboratory markers as alternatives to traditional spinal tap tests.

“Demonstration of CVS by MRI can be used to diagnose multiple sclerosis. It can increase the specificity for the diagnosis, but we were also clear and notified that you didn’t require it,” Dr Ontaneda noted.

The updated criteria bring different forms of MS under one diagnostic system and, under certain conditions, recognise early signs detected only through scans.

Ontaneda cautioned that the criteria were intended to guide doctors rather than replace their clinical judgement.

“The diagnostic criteria are a rule or a set of guides to make a diagnosis of MS,” he said, adding that clinicians must always ensure alternative explanations are thoroughly excluded.

The presentation also emphasised everyday health habits and symptom management as foundations of care. Ontaneda advised cardiovascular exercise, quitting smoking, and regular checks for high blood pressure, diabetes, and high cholesterol to help protect brain health.

Helping patients take charge of their daily habits could also provide a significant psychological boost, Dr Ortaneda said.

“I actually find this especially powerful because this actually allows patients to feel like they’re taking control of their disease, knowing that they could improve their diet, improve their exercise routines, their day-to-day activities, and it gives them a sense of empowerment. So really don’t underestimate this at all.”

The forum ended with a call for faster medical teamwork, cooperation among specialists and healthy lifestyle changes to improve patient care.

(RR)