Expanded Disability Status Scale (EDSS) / Functional Systems Score (FSS)
Describes severity of disability in patients with MS.
4.0--Fully ambulatory, self-sufficient, up 12 hours a day despite relatively severe disability. Able to walk ≥500 meters without aid/rest.
4.5--Fully ambulatory, able to work a full day, may require minimal assistance. Able to walk ≥300 meters without aid/rest.
5.0--Ambulatory for 200 meters without aid/rest; disability that impairs full daily activities (eg, to work full day without special provisions).
5.5--Ambulatory for 100 meters without aid/rest; disability precludes full daily activities.
6.0--Intermittent or unilateral constant assistance required to walk 100 meters, with/without resting.
6.5--Constant bilateral assistance (canes, crutches, or braces) required to walk 20 meters without resting.
7.0--Unable to walk >5 meters even with aid; (restricted to wheelchair); wheels self in standard wheelchair and transfers alone.
7.5--Unable to take more than steps; restricted to wheelchair; may need aid in transfer; wheels self but cannot use standard wheelchair a full day; may require motorized wheelchair.
8.0--Restricted to bed/chair or perambulated in wheelchair, but may be out of bed itself much of the day; retains many self-care functions; generally has effective use of arms.
8.5--Restricted to bed much of the day; has some effective use of arms; retains some self-care functions.
9.0--Helpless bed patient; can communicate and eat.
9.5--Totally helpless bed patient; unable to communicate effectively or eat/swallow.
10.0--Death due to MS.
Abnormal signs without disability+1
Mild or moderate paraparesis or hemiparesis; severe monoparesis+3
Marked paraparesis or hemiparesis; moderate quadriparesis; or monoplegia+4
Paraplegia, hemiplegia, or marked quadriparesis+5
Abnormal signs without disability+1
Moderate truncal or limb ataxia+3
Severe ataxia, all limbs+4
Unable to perform coordinated movements due to ataxia+5
Moderate nystagmus or other mild disability+2
Severe nystagmus, marked extraocular weakness, or moderate disability of other cranial nerves+3
Marked dysarthria or other marked disability+4
Inability to swallow or speak+5
Vibration or figure-writing decrease only, in 1-2 limbs+1
Mild decrease in touch, pain or position sense, and/or moderate decrease in vibration in 1-2 limbs; or vibratory decrease alone in 3-4 limbs+2
Moderate decrease in touch, pain or position sense, and/or lost vibration in 1-2 limbs; or mild decrease in touch, pain and/or moderate decrease in all proprioceptive tests in 3-4 limbs+3
Marked decrease in touch or pain or loss of proprioception, alone or combined, in 1-2 limbs; or moderate decrease in touch, pain and/or severe proprioceptive decrease in >2 limbs+4
Loss of sensation in 1-2 limbs; or moderate decrease in touch, pain and/or loss of proprioception for most of the body below the head+5
Sensation essentially lost below the head+6
Mild urinary hesitancy, urgency, or retention+1
Moderate hesitancy, urgency, retention of bowel or bladder, or rare urinary incontinence+2
Frequent urinary incontinence+3
In need of almost constant catheterization+4
Loss of bladder function+5
Loss of bowel and bladder function+6
Scotoma with visual acuity (corrected) better than 20/30+1
Worse eye with scotoma with maximal visual acuity (corrected) of 20/30 to 20/59+2
Worse eye with large scotoma, or moderate decrease in fields, but with maximal visual acuity (corrected) of 20/60 to 20/99+3
Worse eye with marked decrease of fields and maximal visual acuity (corrected) of 20/100-20/200; grade 3 plus maximal acuity of better eye of ≤20/60+4
Worse eye with maximal visual acuity (corrected) less than 20/200; grade 4 plus maximal acuity of better eye of 20/60 or less+5
Grade 5 plus maximal visual acuity of better eye of 20/60 or less+6
Mood alteration only (Does not affect DSS score)+1
Mild decrease in mentation+2
Moderate decrease in mentation+3
Marked decrease in mentation (chronic brain syndrome -- moderate)+4
Dementia or chronic brain syndrome -- severe or incompetent+5
Any other neurologic findings attributed to MS+1
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