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Journal Article Epublish 1 citation

PubMed: 42318246 DOI: 10.3389/fneur.2026.1812690

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

Front Neurol 17:1812690

Authors: Per Soelberg Sörensen, Paola F Zaratin, Mario Alberto Battaglia, Gilles Edan, Sara Samadzadeh, Letizia Leocani, Jefferson Becker, Jose Flores, Fernando Hamuy, Edgardo Cristiano, Liliana Patrucco, Xavier Montalbán, Hans-Peter Hartung, Giancarlo Comi, Oscar F Fernandez

Affiliations

  • Danish Multiple Sclerosis Center, Department of Neurology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
  • Fondazione Italiana Sclerosi Multipla, Genoa, Italy.
  • Department of Neurology, Rennes University Hospital, Rennes, France.
  • Charite - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Berlin, Germany.
  • Faculty of Medicine, Vita-Salute San Raffaele University, Milan, Italy.
  • Experimental Neurophysiology Unit, Institute of Experimental Neurology (INSPE) - IRCCS San Raffaele Scientific Institute, Milan, Italy.
  • Department of Neurology and Psychiatry, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil.
  • National Institute of Neurology and Neurosurgery, CAMINEMOS.MX, Mexico City, Mexico.
  • National Multiple Sclerosis Center IMT Hospital, Ministry of Health of Paraguay, Asuncion, Paraguay.
  • Multiple Sclerosis Centre Buenos Aires (CemBA), Buenos Aires, Argentina.
  • Servei de Neurologia and Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Institut de Recerca Vall d'Hebron (VHIR), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
  • Center for Networked Biomedical Research on Neurodegenerative Diseases (CIBERNED) - ISCIII, Madrid, Spain.
  • Department of Neurology, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.
  • Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia.
  • Department of Neurology, Palacky University Olomou, Olomouc, Czechia.
  • Universita Vita Salute San Raffaele, Milan, Italy.
  • Department of Pharmacology, Faculty of Medicine, University of Malaga, Institute of Biomedical Research of Malaga (IBIMA), Malaga, Spain.

Abstract

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 (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.

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.

MeSH

Sclerosis, Multiple Sclerosis, Cross-Sectional Studies, Classification, Therapeutics, Benchmarking, Workforce