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 ( 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.