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

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.

To characterize the global landscape of MS centers and evaluate compliance with multidisciplinary standards using a simplified, scalable classification framework.

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.

Academic centers reported higher workloads: mean annual treatments 1,359.6 vs. 779.3 (p = 0.0003) and treated relapses 181.4 vs. 84.1 (p < 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 (p = 0.0001 and p = 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.

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.