EDSS Pocketcard

Expanded Disability Status Scale Definition (1) The Kurtzke Expanded Disability Status Scale (EDSS) remains the goldstandard measure for assessing level of disability. It is an ordinal scale with 19 disease steps between 0 and 10. The scale measures impairment or activity limitation based on the examination of eight functional systems plus ambulation, and is ideally administered by an experienced and EDSS-accredited physician.

How is the EDSS quantified? (2) The EDSS helps to quantify the level of disability in MS and helps to identify which patients can start on DMARDS (disease modifying medications). The EDSS quantifies disability in eight functional systems (FS) and allows neurologists to assign a Functional System Score (FSS) for each of them. Most people with EDSS scores 5.5 have progressive MS, have difficulty walking and may not be able to work. These functional systems are: Pyramidal (i.e. weakness or difficulty moving limbs); Cerebellar ataxia, loss of coordination or presence of tremor); Brainstem (i.e. problems with speech, swallowing and/or presence of nystagmus); Sensory (i.e. numbness or loss of sensations); Bowel and bladder functions; Visual function; Cerebral (or mental) functions; Other

FSS - Pyramidal functions* (2, 3)

SCORE FUNCTION 0

Normal

1

Abnormal signs without disability

2

Minimal disability

3

Mild to moderate paraparesis or hemiparesis (detectable weakness, but most functions sustained for short periods, fatigue problem); severe monoparesis (almost no function)

4

Marked paraparesis or hemiparesis (function is difficult), moderate quadriparesis (function is decreased, but can be sustained for short periods); or monoplegia

5

Paraplegia, hemiplegia; or marked quadriparesis

6

Quadriplegia

9

Unknown

* FSS stands for Fatigue Severity Scale

FSS - Cerebellar Functions (2, 3)

SCORE FUNCTION 0

Normal

1

Abnormal signs without disability

2

Mild ataxia (tremor or clumsy movements easily seen, minor interference with function)

3

Moderate truncal or limb ataxia (tremor or clumsy movements interfere with function in all spheres)

4

Severe ataxia in all limbs (most functions are very difficult)

5

Unable to perform coordinated movements due to ataxia

9

Unknown

Record #1 in small box when weakness (grade 3 or worse on pyramidal) interferes with testing.

FSS - Brainstem functions* (2, 3)

SCORE FUNCTION 0

Normal

1

Signs only

2

Moderate nystagmus or other mild disability

3

Severe nystagmus, marked extra-ocular weakness, or moderate disability of other cranial nerves

4

Marked dysarthria or other marked disability

5

Inability to swallow or to speak

9

Unknown

FSS - Sensory functions* (2, 3)

SCORE FUNCTION 0

Normal

1

Vibration or figure-writing decrease only in one or two limbs

2

Mild decrease in touch or pain or position sense, and/or moderate decrease in vibration in one or two limbs; or vibratory (c/s figure writing) decrease alone in three or four limbs

3

Moderate decrease in touch or pain or position sense, and/or essential loss of vibration in one or two limbs; or mild decrease in touch or pain and/or moderate decrease in all proprioceptive tests in three or four limbs

4

Marked decrease in touch or pain or loss of proprioception, alone or combined, in one or two limbs; or moderate decrease in touch or pain and/or severe proprioceptive decrease in more than two limbs

5

Loss (essential) of sensation in one or two limbs; or moderate decrease in touch or pain and/or loss of proprioception for most of the body below the head

6

Sensation essentially lost below the head

9

Unknown

FSS - Bowel and Bladder functions* (2, 3) (Rating on the basis of the worse function, either bowel or bladder)

SCORE FUNCTION 0

Normal

1

Mild urinary hesitancy, urgency, or retention

2

Moderate hesitancy, urgency, retention of bowel or bladder retention, or rare urinary incontinence (intermittent self-catheterization, manual compression to evacuate bladder, or finger evacuation of stool)

3

Frequent urinary incontinence

4

In need of almost constant catheterization (and constant use of measures to evacuate stool)

5

Loss of bladder function

6

Loss of bowel and bladder function

9

Unknown

FSS - Visual functions* (2, 3)

SCORE FUNCTION 0

Normal

1

Scotoma with visual acuity (corrected), better than 20/30

2

Worse eye with scotoma with maximal visual acuity (corrected) of 20/30-20/59

3

Worse eye with large scotoma, or moderate decrease in fields, but with maximal visual acuity (corrected) of 20/60–20/99

4

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 or less

5

Worse eye with maximal visual acuity (corrected), less than 20/200; grade 4 plus maximal acuity of better eye of 20/60 or less

6

Grade 5 plus maximal visual acuity of better eye of 20/60 or less

9

Unknown

FSS - Cerebral (or Mental) functions* (2, 3)

SCORE FUNCTION 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 (chronic brain syndrome - moderate)

5

Dementia or chronic brain syndrome - severe or incompetent

6

Unknown

Kurtzke Expanded Disability Status Score (2, 4)

SCORE

SIGNS

FUNCTIONAL SYSTEM: (FS) scores

0.0

Normal

All grade 0*

1.0

No disability

Minimal signs in one FS (i.e., grade 1)

1.5

No disability

Minimal signs in more than one FS (> one FS grade 1)

2.0

Minimal disability in one FS

One FS grade 2, others 0 or 1

2.5

Minimal disability in two FS

Two FS grade 2, others 0 and 1

3.0

Fully ambulatory

Moderate disability in one FS (one FS grade 3, others 0 or 1). Mild disability in three to four FS (three or four FS grade 2, others 0 or 1)

3.5

Fully ambulatory

Moderate disability in one FS (one FS grade 3, others 0 or 1). Mild disability in three to four FS (three or four FS grade 2, others 0 or 1)

SIGNS

FUNCTIONAL SYSTEM: (FS) scores

4.0

Fully ambulatory without aid, self-sufficient, up and about some 12 hours a day. Able to walk without aid or rest +/- 500m.

Severe disability consisting of one FS grade 4 (others 0 or 1); or combination of lesser grades exceeding limits of previous steps.

4.5

Fully ambulatory without aid, up and about much of the day, able to work a full day, may otherwise have some limitation of full activity or require minimal assistance. Able to walk without aid or rest +/- 300m.

Relatively severe disability usually consisting of one FS grade 4 (others 0 or 1); or combinations of lesser grades exceeding limits of previous steps.

5.0

Ambulatory without aid or rest for +/- 200m. Disability severe enough to impair full daily activities (e.g., to work a full day without special provisions).

Usual FS equivalents are one grade 5 alone (others 0 or 1); or combinations of lesser grades usually exceeding specifications for step 4.0.

5.5

Ambulatory without aid for +/- 100m. Disability severe enough to preclude full daily activities.

Usual FS equivalents are one grade 5 alone (others 0 or1); or combination of lesser grades usually exceeding that of step 4.0.

6.0

Intermittent or unilateral constant assistance (cane, crutch, brace) required to walk +/- 100m with or without resting.

Usual FS equivalents are combinations with more than two FS grade 3+.

6.5

Constant bilateral assistance (canes, crutches, braces) required to walk +/- 20m without resting.

Usual FS equivalents are combinations with more than two FS grade 3+.

7.0

Unable to walk beyond +/5m even with aid, essentially restricted to wheelchair; wheels self in standard wheel chair and transfers alone; up and about in wheelchair some 12 hours a day.

Usual FS equivalents are combinations with more than one FS grade 4+; very rarely pyramidal grade 5 alone.

SCORE

SCORE

SIGNS

FUNCTIONAL SYSTEM: (FS) scores

7.5

Unable to take more than a few steps; restricted to wheelchair; may need aid in transfer; wheels self but cannot carry on in standard wheelchair a full day; may require motorized wheelchair.

Usual FS equivalents are combinations with more than one FS grade 4+.

8.0

Essentially restricted to bed or 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.

Usual FS equivalents are combinations, generally grade 4+ in several systems.

8.5

Essentially restricted to bed Usual FS equivalents are commuch of day; has some efbinations; generally grade fective use of arm(s); retains 4+ in several systems. some self-care functions.

9.0

Helpless bed patient; can communicate and eat.

Usual FS equivalents are combinations; mostly grade 4+.

9.5

Totally helpless bed patient; unable to communicate effectively or eat/swallow.

Usual FS equivalents are combinations; almost all grade 4+.

10.0

Death due to MS

* Excludes cerebral function grade 1 Note 1: EDSS steps 1.0 to 4.5 refer to patients who are fully ambulatory and the precise step number is defined by the Function System scores(s). EDSS steps 5.0 to 9.5 are defined by the impairment to ambulation and usual equivalents in Functional System scores are provided. Note 2: EDSS should not change by 1.0 step unless there is a change in the same direction of at least one step in at least one FS.

©2011 BBD, Ltd.

Expanded Disability Status Scale Chart (2, 4)

0

1,0

2,0

3,0

4,0

5,0

6,0

7,0

8,0

9,0

no minimal moderate relatively disability assistance restricted restricted Confined disability disability disability severe affects daily required to to bed or to bed disability routine to work wheelchair wheelchair

Adapted from Reference 2: Hauser SL & Goodin DS and Reference 4: National Multiple Sclerosis Society.

The Multiple Sclerosis Functional Composite Scale (MFSC) involves testing of cognitive capacities of a patient and examines the following in the order shown: (1, 5) Trial 1 Trial 2 Trial 1 Trial 2 Trial 1 Trial 2

Timed 25-Foot Walk Timed 25-Foot Walk Dominant Hand Dominant Hand Non-Dominant Hand Non-Dominant Hand

9-Hole Peg Test 9-Hole Peg Test 9-Hole Peg Test 9-Hole Peg Test

Paced Auditory Serial Addition Test-3’ (PASAT)

References 1. Gray O, Butzkueven H. Measurement of disability in multiple sclerosis. Neurol Asia 2008; 13: 153 – 156. 2. Hauser SL, Goodin DS. Multiple Sclerosis and Other Demyelinating Diseases. In: Harrison’s principles of internal medicine. Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson JL, Loscalzo J, editors. 18th ed. New York: McGraw-Hill Professional. 2012; chapter 380: 3395-3409. 3. National Multiple Sclerosis Society. Kurtzke functional systems scores (FSS). Available from: http://www.nationalmssociety.org/search-results index.aspx?q=Kurtzke+Functional+Systems+Scores+%28FSS%29+&star=0&num=20. Accessed 15 6 2011. 4. National Multiple Sclerosis Society. Kurtzke expanded disability status scale (EDSS). Available from: http://www.nationalmssociety.org/search-results/index.aspx?q=Kurtzke+expanded+disability+status+ scale+%28EDSS%29+&start=0&num=20. Accessed 15 6 2011. 5. Fischer JS, Jak AJ, Kniker JE, Rudick RA, Cutter G. Multiple Sclerosis Functional Composite (MSFC). Administration and scoring manual. New York: National Multiple Sclerosis Society. 2001.

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