Abstract：
The last consensus statement of the Spanish Society of Neurology\'s Demyelinating Diseases Study Group on the treatment of multiple sclerosis (MS) was issued in 2016. Although many of the positions taken remain valid, there have been significant changes in the management and treatment of MS, both due to the approval of new drugs with different action mechanisms and due to the evolution of previously fixed concepts. This has enabled new approaches to specific situations such as pregnancy and vaccination, and the inclusion of new variables in clinical decision-making, such as the early use of high-efficacy disease-modifying therapies (DMT), consideration of the patient\'s perspective, and the use of such novel technologies as remote monitoring. In the light of these changes, this updated consensus statement, developed according to the Delphi method, seeks to reflect the new paradigm in the management of patients with MS, based on the available scientific evidence and the clinical expertise of the participants. The most significant recommendations are that immunomodulatory DMT be started in patients with radiologically isolated syndrome with persistent radiological activity, that patient perspectives be considered, and that the term \"lines of therapy\" no longer be used in the classification of DMTs (> 90% consensus). Following diagnosis of MS, the first DMT should be selected according to the presence/absence of factors of poor prognosis (whether epidemiological, clinical, radiological, or biomarkers) for the occurrence of new relapses or progression of disability; high-efficacy DMTs may be considered from disease onset.
摘要：
西班牙神经病学会脱髓鞘疾病研究小组关于多发性硬化症（MS）治疗的最后一份共识声明于2016年发布。尽管采取的许多立场仍然有效，MS的管理和治疗发生了重大变化，这既是由于具有不同作用机制的新药的批准，也是由于先前固定概念的演变。这使得针对怀孕和疫苗接种等特定情况采取了新的方法，在临床决策中加入新的变量，例如早期使用高效的疾病改善疗法（DMT），考虑患者的观点，以及远程监控等新技术的使用。鉴于这些变化，这份最新的共识声明，根据德尔菲法开发，试图反映MS患者管理的新范式，基于现有的科学证据和参与者的临床专业知识。最重要的建议是，在放射学孤立综合征持续放射学活动的患者中开始免疫调节DMT。考虑患者的观点，术语“治疗路线”不再用于DMT的分类(>90%共识)。在MS诊断后，应根据预后不良因素的存在/不存在（无论是流行病学，临床,放射学,或生物标志物）用于新复发或残疾进展的发生；从疾病发作开始，可以考虑使用高效DMT。
