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    Expanded Disability Status Scale (EDSS) / Functional Systems Score (FSS)

    Describes severity of disability in patients with MS.
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    Pearls/Pitfalls
    • The Expanded Disability Status Scale (EDSS) works together with the Functional Systems Scale (FSS) to measure MS disease progression.
    • The EDSS assesses the disability status of MS patients on a scale from 0 to 10.
    • Scores from 0 to 3.5 are determined by deficits in eight Functional Systems (FS) in patients who do not have any impairment of ambulation.
    • Scores from 4.0 to 10.0 are determined both by ambulatory ability and FS deficits, which typically correlate with each other.
    • Some providers use only the ambulatory score to determine the overall EDSS score between 4.0 and 10.0.
    • In situations when there is subjectivity and FS deficits do not correspond to a specific EDSS level, a range is provided.
    Ambulation Scoring
    0--Fully ambulatory
    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.
    Functional Systems
    Normal
    0
    Abnormal signs without disability
    +1
    Minimal disability
    +2
    Mild or moderate paraparesis or hemiparesis; severe monoparesis
    +3
    Marked paraparesis or hemiparesis; moderate quadriparesis; or monoplegia
    +4
    Paraplegia, hemiplegia, or marked quadriparesis
    +5
    Quadriplegia
    +6
    Normal
    0
    Abnormal signs without disability
    +1
    Mild ataxia
    +2
    Moderate truncal or limb ataxia
    +3
    Severe ataxia, all limbs
    +4
    Unable to perform coordinated movements due to ataxia
    +5
    Normal
    0
    Signs only
    +1
    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
    Normal
    0
    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
    Normal
    0
    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
    Normal
    0
    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
    Normal
    0
    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
    Normal
    0
    Any other neurologic findings attribugted to MS
    +1

    Result:

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    Next Steps
    Evidence
    Creator Insights

    Advice

    Use to measure progression of disease in MS patients.

    Use to compare outcomes in MS clinical trials.

    Formula

    EDSS: Points assigned based on level of disability.

    FSS: Addition of selected points within body system.

    Facts & Figures

    Score of 1.0 to 4.5 -- Normal ambulation.

    Score of 5.0 to 9.5 -- Impaired ambulation.

    Dr. John F. Kurtzke

    About the Creator

    John F. Kurtzke, MD, (d. 2015) was professor emeritus of neurology at Georgetown University. He was a leading expert in the study of multiple sclerosis (MS) and a contributor in the creation of the field of neuroepidemiology. Dr. Kurtzke authored over 200 peer-reviewed articles and received multiple awards for MS research including the Charcot Award from the MS International Federation.

    To view Dr. John F. Kurtzke's publications, visit PubMed