MS Scales

The EDSS is the most commonly used scale.  The EDSS can help physicians monitor changes in the level of disability over time. It is widely used in clinical trials and in the assessment of people with MS.  The EDSS focuses mainly on your ability to walk. In general, the EDSS can be broken down like this:

0 = Normal.

1-1.5 = No disability, but some abnormal neurological signs.

2-2.5 = Minimal disability.

3-4.5 = Moderate disability, affecting daily activities, but a patient can still walk.

5-8 = More severe disability, impairing one’s daily activities and requiring assistance with walking.

8.5-9.5 = Very severe disability, restricting a patient to bed.

10 = Death.

MS doctors may also assess a patient's AI.

0 = Asymptomatic; fully active.

1 = Walks normally but reports fatigue which interferes with athletic or other demanding activities.

2 = Abnormal gait or episodic imbalance; gait disorder is noticeable to family and friends. Able to walk 25 feet in 10 seconds or less.

3 = Walks independently; able to walk 25 feet in between 11-20 seconds.

4 = Requires unilateral support (cane, single crutch) to walk. Walks 25 feet in 20 seconds or less.

5 = Requires unilateral support but walks 25 feet in greater than 20 seconds or requires bilateral support (canes, crutches, walker) and walks 25 feet in 20 seconds or less.

6 = Requires bilateral support and walks 25 feet in greater than 20 seconds. (May use wheelchair on occasion)*

7 = Walking limited to several steps with bilateral support; unable to walk 25 feet. (May use wheelchair most of the time)

8 = Restricted to wheelchair; able to transfer independently.

9 = Restricted to wheelchair; unable to transfer independently.

10 = Bedridden.

MS Doctors also think of the overall disease step and how this evolves over time.

0 = Normal – Functionally normal; no limitations on activity or lifestyle; RR; EDSS=0-1.5; AI=0; may have minor abnormality on exam (eg nystagmus, extensor plantar); attack frequency <1/year; return to baseline with/without treatment and generally not treated.

1 = Mild Disability – Minor, but noticeable signs and/or symptoms (eg. sensory symptoms, minor bladder problems, fatigue); RR or very early CP; EDSS=2-2.5; AI=0-1 (ie-no visible abnormality of gait); attack frequency=1-2/year.

2 = Moderate Disability – Main feature=abnormality of gait; AI=2-3; EDSS=2-4.5; able to work full day, but may find athletic activities difficult; RR-P or early CP; may need cane with attack but recover to independent ambulation.

3 = Early Cane –  EDSS=6; RR-P or CP; AI=2-3; may use a cane/unilateral support (eg spouse's arm) outside for greater distances, but can walk 25 feet in 20 seconds or less without a cane.

4 = Late Cane – EDSS=6; RR-P or CP; AI=4-5; unable to walk 25 ft. without a cane/unilateral support(eg may hang on to furniture inside home or touch wall in clinic; use cane outside; may need a scooter for greater distances (eg in malls).

5 = Bilateral Support – EDSS=6.5; AI=5-6; require bilateral support to walk 25 feet (eg 2 canes or crutches or walker); may use a scooter for greater distances.

6 = Wheelchair – EDSS > 7; AI > 7; confined to wheelchair; may be able to take 1 or 2 steps, but cannot ambulate 25 feet even with bilateral support; may have further progression including problems with use of hands, inability to transfer.

U = Unclassifiable – Used for patients who do not fit above classification; eg-significant cognitive or visual impairment.

The MSFC is a newer measurement system. It is sensitive to changes other than mobility. The MSFC often takes a bit more time to complete, so it is currently used less in clinic and more in clinical trials.

The MSFC measures the following:

• Walking speed, using a timed 25-foot walk
• Arm and hand dexterity, using a nine-hole peg test
• Cognitive function, such as how well a patient can do math calculations, using the Paced Auditory Serial Additions Test (PASAT)

0
Normal

1
Abnormal signs without disability

2
Minimal disability

3
Mild or moderate paraparesis or hemiparesis; severe monoparesis

4
Marked paraparesis or hemiparesis; moderate quadriparesis; or monoplegia

5
Paraplegia, hemiplegia, or marked quadriparesis

6
Quadriplegia

0
Normal

1
Abnormal signs without disability

2
Mild ataxia

3
Moderate truncal or limb ataxia

4
Severe ataxia all limbs

5
Unable to do coordinated movements due to ataxia

X
Is used after each number when weakness (grade 3 or more on pyramidal) interferes with testing

0
Normal

1
Signs only

2
Moderate nystagmus, or other mild disability

3
Severe nystagmus, marked extraocular weakness, or moderate disability of other cranial nerves

4
Marked dysarthria or other marked disability

5
Inability to swallow or speak

0
Normal vibration (VIB)/position sense (PS)

1
Mild l VIB in 1 or 2 limbs; PS normal

2
Moderate l VIB &/or mild l PS in 1 or 2 limbs OR mild l VIB in 3 or 4 limbs; PS normal

3
Lost VIB &/or moderate l PS in 1 or 2 limbs OR moderate l PS in 3 or 4 limbs

4
Lost PS in 1 or 2 limbs OR severe l PS in 3 or 4 limbs

5
Lost PS in 3 or 4 limbs

6
Sensation lost below the head

0
Normal

1
Mild hesitancy, urgency, or retention

2
Moderate hesitancy, urgency, or retention, or rare urinary incontinence

3
Frequent incontinence

4
In need of almost constant catheterization

5
Loss of bladder control

6
Loss of bowel and bladder control

0
Normal

1
Scotoma with acuity better than 20/30

2
Worse eye=20/30-20/59

3
Worse eye=20/60-20/99

4
Worse eye=20/100-20/200 OR #3 + better eye worse than or=to 20/60

5
Worse eye less than 20/200 OR #4 + better eye worse than or=to 20/60

6
#5 + better eye worse than or=to 20/60

0
Normal

1
Mood alteration only (does not affect EDSS score)

2
Mild decrease in mentation

3
Moderate decrease in mentation

4
Marked decrease in mentation

5
Dementia – severe or incompetent

0
Normal

1
Mild-minor problems with coordinated tasks

2
Moderate-unable to write clearly

3
Severe-unable to feed self

0
Normal

1
Mild-minor problems with coordinated tasks

2
Moderate-unable to write clearly

3
Severe-unable to feed self