As Caribbean health systems work to improve outcomes for people living with multiple sclerosis (MS), medical experts from Barbados and across the region have gathered for a specialized forum to push for systemic changes in how the neurological condition is detected and treated, with over 70 active diagnosed cases currently tracked in Barbados.
Hosted at the Hilton Hotel, the meeting brought together local and regional physicians alongside a leading international MS researcher to explore how timely diagnosis and coordinated care can alter the long-term trajectory of this chronic neurological condition that disrupts central nervous system function. Dr. Daniel Ontaneda, neurology professor and research director at the Cleveland Clinic Neurological Institute in Florida, a top U.S. MS treatment center, led discussions on the global evolution of MS understanding, diagnostic practices and treatment approaches, stressing that updating local care standards in Barbados is critical to boosting long-term patient outcomes.
Ontaneda emphasized that MS care must extend far beyond managing physical medical symptoms. Effective care should prioritize preserving patients’ independence, ability to maintain employment, and overall daily quality of life, shifting focus from disability to functional ability. “We need to focus on patient ability rather than their disability, and suggest work adaptations such as adjusting work hours, adjusting job roles to maintain employment, and anticipating the need for allied health services, and have local go-to professionals to whom we can refer,” Ontaneda explained.
At the core of his presentation was the urgent need for earlier symptom recognition, faster referrals to neurology specialists, and integrated multidisciplinary care that includes primary care providers, therapists and other medical specialists. He also highlighted the critical role of healthy lifestyle adjustments and proactive management of coexisting health conditions to slow disease progression.
A central focus of the forum was the 2024 revision of the McDonald Criteria, the globally accepted gold-standard guidelines that neurologists rely on to diagnose MS. These guidelines combine patient symptom reports, physical exams, imaging and laboratory testing to identify characteristic central nervous system damage while ruling out other conditions that can mimic MS.
The 2024 update brings key changes designed to enable earlier and more accurate diagnosis. Most notably, the revision formally adds the optic nerve as an additional assessed site of MS-related damage, and integrates advanced imaging features and new laboratory markers to speed up detection. While some new lab tests can reduce reliance on traditional spinal taps, the procedure remains necessary in certain diagnostic cases.
Ontaneda noted that older diagnostic frameworks carried a significant risk of misdiagnosis. Data from North America and Latin America shows that roughly one in five people initially diagnosed with MS were eventually found to have been misdiagnosed. Common errors included mistaking age-related blood vessel wear or damage from other unrelated conditions for MS lesions.
The 2024 criteria address this gap by adding new tools that boost diagnostic accuracy. It unifies diagnostic standards for all forms of MS under one framework, and recognizes asymptomatic early signs of the disease detected only through imaging, in specific circumstances. Crucially, Ontaneda clarified that the updated guidelines are designed to support, not replace, a clinician’s independent professional judgment. “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 for symptoms are thoroughly ruled out before confirming an MS diagnosis.
Beyond diagnosis and treatment, the forum reinforced evidence that proactive everyday health management is a foundational part of MS care. Ontaneda recommended regular cardiovascular exercise, smoking cessation, and routine screening for conditions including high blood pressure, diabetes and high cholesterol to protect long-term brain health. Encouraging patients to adopt these healthy habits also delivers meaningful psychological benefits, he added, giving patients a sense of control over their condition. “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,” Ontaneda said.
The forum concluded with a unified call to action: to streamline care coordination across medical specialties, speed up referrals for suspected MS cases, and integrate lifestyle guidance into routine MS care to improve outcomes for patients across Barbados.