Consensus for the Early Identification of Secondary Progressive Multiple Sclerosis in Portugal: a Delphi Panel


  • Maria José Sá Serviço de Neurologia. Centro Hospitalar e Universitário de São João. Porto.
  • Carlos Basílio Serviço de Neurologia. Centro Hospitalar Universitário do Algarve. Faro.
  • Carlos Capela Serviço de Neurologia. Centro Hospitalar Universitário de Lisboa Central. Lisboa.
  • José João Cerqueira Serviço de Neurologia. Hospital de Braga. Braga.
  • Irene Mendes Serviço de Neurologia. Hospital Garcia de Orta. Almada.
  • Armando Morganho Serviço de Neurologia. Hospital Dr. Nélio Mendonça. Funchal.
  • João Correia de Sá Serviço de Neurologia. Hospital de Santa Maria. Centro Hospitalar Universitário de Lisboa Norte. Lisboa.
  • Vasco Salgado Serviço de Neurologia. Hospital Professor Doutor Fernando Fonseca. Amadora.
  • Ana Martins Silva Serviço de Neurologia. Centro Hospitalar Universitário do Porto. Porto.
  • José Vale Serviço de Neurologia. Hospital Beatriz Ângelo. Loures.
  • Lívia Sousa Serviço de Neurologia. Centro Hospitalar e Universitário de Coimbra. Coimbra.



Consensus, Multiple Sclerosis, Chronic Progressive/diagnosis, Portugal


Introduction: Multiple sclerosis is a disease with a heterogeneous evolution. The early identification of secondary progressive multiple sclerosis is a clinical challenge, which would benefit from the definition of biomarkers and diagnostic tools applicable in the transition phase from relapsing-remitting multiple sclerosis to secondary progressive multiple sclerosis. We aimed to reach a Portuguese national consensus on the monitoring of patients with multiple sclerosis and on the more relevant clinical variables for the early identification of its progression.
Material and Methods: A Delphi panel which included eleven Portuguese Neurologists participated in two rounds of questions between July and August of 2021. In the first round, 39 questions which belonged to the functional, cognitive, imaging, biomarkers and additional evaluations were included. Questions for which no consensus was obtained in the first round (less than 80% of agreement), were appraised by the panel during the second round.
Results: The response rate was 100% in both rounds and consensus was reached for a total of 33 questions (84.6%). Consensus was reached for monitoring time, evaluation scales and clinical variables such as the degree of brain atrophy and mobility reduction, changes suggestive of secondary progressive multiple sclerosis. Additionally, digital devices were considered tools with potential to identify disease progression. Most questions for which no consensus was obtained referred to the cognitive assessment and the remaining referred to both functional and imaging domains.
Conclusion: Consensus was obtained for the determination of the monitorization interval and for most of the clinical variables. Most questions that did not reach consensus were related with the confirmation of progression taking into account only one test/domain, reinforcing the multifactorial nature of multiple sclerosis.


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How to Cite

Sá MJ, Basílio C, Capela C, Cerqueira JJ, Mendes I, Morganho A, Correia de Sá J, Salgado V, Martins Silva A, Vale J, Sousa L. Consensus for the Early Identification of Secondary Progressive Multiple Sclerosis in Portugal: a Delphi Panel. Acta Med Port [Internet]. 2023 Feb. 3 [cited 2023 Mar. 30];36(3):167-73. Available from: