During the last 25 years, multiple sclerosis (MS) has seen major changes with new diagnostic criteria, a better identification of disease, individualization of disease prognosis and the appearance of new therapeutic options. As a result, the management of MS patients has become more complex and challenging. The objective of these consensus recommendations was to review how the disease should be managed in Ecuador to improve short, mid and long-term outcomes in affected patients. Methods: A panel of experts in neurology from Ecuador, dedicated to the diagnosis and care of MS patients, gathered virtually during 2023 and 2024 to carry out consensus recommendations on the management of MS patients. To achieve consensus, the methodology of “formal consensus-RAND/UCLA method” was used. Results: Recommendations were established based on published evidence and expert opinion. Recommendations focused on diagnosis, disease prognosis and tailored treatment, treatment failure identification and the pharmacovigilance process. Conclusions: The recommendations of these consensus guidelines attempt to optimize the health care and management of patients with MS in Ecuador.