Meca-Lallana José E, Casanova Bonaventura, Rodríguez-Antigüedad Alfredo, Eichau Sara, Izquierdo Guillermo, Durán Carmen, Río Jordi, Hernández Miguel Ángel, Calles Carmen, Prieto-González José M, Ara José Ramón, Uría Dionisio F, Costa-Frossard Lucienne, García-Merino Antonio, Oreja-Guevara Celia
CSUR Multiple Sclerosis and Clinical Neuroimmunology Unit, Neurology Department, Hospital Clínico Universitario Virgen de la Arrixaca, IMIB-Arrixaca, Murcia, Spain.
Department of Neurology, Hospital Universitario y Politécnico La Fe, Valencia, Spain.
Front Neurol. 2022 Jul 28;13:931014. doi: 10.3389/fneur.2022.931014. eCollection 2022.
Early identification of the transition from relapsing-remitting multiple sclerosis (RRMS) to secondary progressive MS (SPMS) can be challenging for clinicians, as diagnostic criteria for SPMS are primarily based on physical disability and a holistic interpretation.
To establish a consensus on patient monitoring to identify promptly disease progression and the most useful clinical and paraclinical variables for early identification of disease progression in MS.
A RAND/UCLA Appropriateness Method was used to establish the level of agreement among a panel of 15 medical experts in MS. Eighty-three items were circulated to the experts for confidential rating of the grade of agreement and recommendation. Consensus was defined when ≥66% agreement or disagreement was achieved.
Consensus was reached in 72 out of 83 items (86.7%). The items addressed frequency of follow-up visits, definition of progression, identification of clinical, cognitive, and radiological assessments as variables of suspected or confirmed SPMS diagnosis, the need for more accurate assessment tools, and the use of promising molecular and imaging biomarkers to predict disease progression and/or diagnose SPMS.
Consensus achieved on these topics could guide neurologists to identify earlier disease progression and to plan targeted clinical and therapeutic interventions during the earliest stages of SPMS.
对于临床医生而言，早期识别复发缓解型多发性硬化症（RRMS）向继发进展型多发性硬化症（SPMS）的转变具有挑战性，因为SPMS的诊断标准主要基于身体残疾情况及整体解读。
就患者监测达成共识，以迅速识别疾病进展以及用于早期识别MS疾病进展的最有用的临床和辅助临床变量。
采用兰德/加州大学洛杉矶分校适宜性方法来确定15名MS医学专家小组的一致程度。向专家们分发了83项内容，以便对一致程度等级和建议进行保密评级。当达成≥66%的一致或不一致意见时，即达成共识。
83项内容中有72项（86.7%）达成了共识。这些内容涉及随访就诊频率、进展的定义、将临床、认知和放射学评估确定为疑似或确诊SPMS诊断的变量、对更准确评估工具的需求以及使用有前景的分子和成像生物标志物来预测疾病进展和/或诊断SPMS。
在这些主题上达成的共识可指导神经科医生更早地识别疾病进展，并在SPMS的最早阶段规划有针对性的临床和治疗干预措施。
