Global overview of multiple sclerosis care units: an international cross-sectional survey

BACKGROUND: Multiple sclerosis care units (MSCUs) are a reference model for multidisciplinary MS care, yet comparable global data on their structure, resources, and performance remain limited. OBJECTIVE: To characterize the global landscape of MS centers and evaluate compliance with multidisciplinary standards using a simplified, scalable classification framework. METHODS: An international cross-sectional survey (2020-2021) collected validated responses from 198 MS centres across 38 countries. Comparative analyses focused on 168 hospital-based centres. MSCUs were initially classified as type I or II based on fulfilment of ≥80% or 70-79% of 22 predefined structural and functional criteria. To enhance reproducibility, a complementary model was developed using 16 essential criteria, one point per fulfilled item; centres meeting ≥14 criteria qualified for classification. Additional thresholds for annual MS patient volume and neurologist staffing differentiated MSCU-I from MSCU-II. Analyses were stratified by region and institution type. RESULTS: Academic centers reported higher workloads: mean annual treatments 1,359.6 vs. 779.3 ( = 0.0003) and treated relapses 181.4 vs. 84.1 ( < 0.0001). Operational data systems were widely used (administrative 81.5%, registries 85.7%), with stronger regional than institutional gradients: Western Europe had greater adoption (e.g., cost-accountability 67.0% vs. 20.6% in Latin America). Serious adverse events averaged 28.9/year with no regional or institutional differences. Diagnostic and therapeutic capacities (EPs, OCT, high-efficacy DMTs, ASCT) varied markedly by region. Among the 168 hospital centers, 141 met inclusion criteria; 120 (71.4%) met MSCU-I and 21 (12.5%) met MSCU-II criteria, while 27 (16.1%) did not meet the MSCU standards. Region was a stronger predictor of MSCU-I status than academic affiliation ( = 0.0001 and  = 0.0458, respectively). Higher national GDP and health expenditure correlated with MSCU-I designation. A minority of mid-volume units (≈500-999 patients/year) with essential staffing may warrant a pragmatic MSCU-III category for benchmarking. CONCLUSION: We provide the broadest overview to date of MSCU structure and operations and propose a practical, reproducible 16-criterion classification framework. Regional context outweighs academic status in predicting MSCU adequacy. Because the dataset is driven predominantly by Europe and Latin America, extrapolation of these findings to under-represented regions, particularly North America and the Rest of the World, should be made with caution. The framework supports practical benchmarking, certification, and targeted capacity-building to reduce regional disparities in diagnostics, information systems, and access to high-efficacy therapies.