While the Caribbean has a lower prevalence of multiple sclerosis (MS) than North America and Europe, black people often experience it more severely, making early diagnosis, referral and multidisciplinary care essential.
This was stressed by neurologists during an Aventa Barbados forum titled Multiple Sclerosis: Changing The Course of MS – Why Early Treatment Matters, held at Hilton Barbados recently.
“In the Caribbean, we do have a lower prevalence than the rest of the world,” Dr Simeona Jacinto, a consultant at the Queen Elizabeth Hospital, told the gathering. She pointed out that Scotland records 402 cases per 100 000 people and the United States between 277 and 377, while limited Caribbean data suggests figures from single digits to just under 100 per 100 000.
Lower numbers, however, do not mean milder illness. “Black, Hispanic and Asian individuals often experience a more severe MS with more disability,” she noted, adding the disease typically begins in young adults aged 20 to 40 and affects women three times as often as men.
Jacinto described MS as a chronic autoimmune disease in which the immune system attacks the myelin in the brain, spinal cord and optic nerve, while nerve degeneration occurs at the same time. She said its toll goes beyond visible disability.
“MS is far more than just focal paralysis. It’s a systemic syndrome causing disruptions of function physically, cognitively, and socially and economically,” she said. Chronic fatigue affects up to 80 per cent of patients, and bladder and bowel problems can seriously affect quality of life, she added.
Untreated, more than 30 per cent of patients historically needed a walking aid within 20 to 25 years. “Early intervention with high-efficacy, disease-modifying therapies fundamentally alters this baseline,” she suggested.
Diagnosing the disease early and accurately was the focus of Dr Daniel Ontaneda, a clinical neurologist at the Cleveland Clinic in Ohio, United States, who also conducts research on diagnostic biomarkers.
“In order to treat a patient, one has to be able to diagnose both early and accurately,” he stressed.
Ontaneda said changes begin well before the first clinical attack. Five to six years earlier, patients often make greater use of the health system for problems such as depression, anxiety, bladder or bowel complaints and infections. Now, MS can be diagnosed even in people without symptoms, reflecting a shift towards defining the disease by its biology rather than by clinical presentation alone, the expert explained.
He cautioned, however, that the criteria were no substitute for clinical judgement. “The diagnostic criteria are not a replacement for making a robust diagnosis of multiple sclerosis,” he stated, noting that MS remains a diagnosis of exclusion, requiring doctors to rule out other explanations.
For primary care physicians, Jacinto said the role extends beyond referral. They can connect patients to support, address mental health early, suggest work adaptations and build a list of local allied health professionals, including physiotherapists, occupational therapists, psychologists and dietitians.
She said lifestyle also matters, so patients should be encouraged to eat well, exercise, stop smoking and manage conditions such as hypertension, diabetes and high cholesterol. “It gives them a sense of empowerment. So really don’t underestimate this at all.”
Her key message to clinicians was early recognition and referral for neurological assessment, supported by multidisciplinary care and healthy lifestyle habits.
(DDS)
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