The 10-point Kurtzke Expanded Disability Status Scale (EDSS) is the most widely accepted clinical disability scale of disability in multiple sclerosis.

The Expanded Disability Status Scale (EDSS) is a method of quantifying disability in multiple sclerosis and monitoring changes in the level of disability over time. It is widely used in clinical trials and in the assessment of people with MS although MS is difficult to assess because of the differences in signs and symptoms.

The scale was developed by a neurologist called John Kurtzke in 1983 as an advance from his previous 10 step Disability Status Scale (DSS).

Advantages of the EDSS are that it is widely used clinically, is easy to administer, and requires no special equipment.

How the Expanded Disability Status Scale (EDSS) Scale Works:

The EDSS scale ranges from 0 to 10 in 0.5 unit increments that represent higher levels of disability. Scoring is based on an examination by a neurologist.

EDSS steps 1.0 to 4.5 refer to people with MS who are able to walk without any aid and is based on measures of impairment in eight functional systems (FS):

The EDSS assigns a severity score to the patient’s clinical status that ranges from 0-10 in increments of 0.5.

The scores from grades 0-4 are determined using functional systems (FS) scales that evaluate dysfunction in the following 8 neurologic systems:

  • Pyramidal (motor functions like walking, weakness or difficulty moving limbs)
  • Cerebellar  (ataxia(loss of coordination), tremors)
  • Brainstem (speech and swallowing, nystagmus (involuntary eye movements))
  • Sensory (numbness or loss of sensations)
  • Bladder and bowel function
  • Vision and Visual function
  • Cerebral (mental functions)
  • Other (other neurological findings during examination)
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EDSS grades are as follows:

Score

Description

*FS = Functional Systems

1.0 No disability, minimal signs in one FS
1.5 No disability, minimal signs in more than one FS
2.0 Minimal disability in one FS
2.5 Mild disability in one FS or minimal disability in two FS
3.0 Moderate disability in one FS, or mild disability in three or four FS. No impairment to walking
3.5 Moderate disability in one FS and more than minimal disability in several others. No impairment to walking
4.0 Significant disability but self-sufficient and up and about some 12 hours a day. Able to walk without aid or rest for 500m
4.5 Significant disability but 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 for 300m
5.0 Disability severe enough to impair full daily activities and ability to work a full day without special provisions. Able to walk without aid or rest for 200m
5.5 Disability severe enough to preclude full daily activities. Able to walk without aid or rest for 100m
6.0 Requires a walking aid – cane, crutch, etc – to walk about 100m with or without resting
6.5 Requires two walking aids – pair of canes, crutches, etc – to walk about 20m without resting
7.0 Unable to walk beyond approximately 5m even with aid. Essentially restricted to wheelchair; though wheels self in standard wheelchair and transfers alone. Up and about in wheelchair some 12 hours a day
7.5 Unable to take more than a few steps. Restricted to wheelchair and may need aid in transferring. Can wheel self but can not carry on in standard wheelchair for a full day and may require a motorised wheelchair
8.0 Essentially restricted to bed or chair or pushed in wheelchair. May be out of bed itself much of the day. Retains many self-care functions. Generally has effective use of arms
8.5 Essentially restricted to bed much of day. Has some effective use of arms retains some self care functions
9.0 Confined to bed. Can still communicate and eat
9.5 Confined to bed and totally dependent. Unable to communicate effectively or eat/swallow
10.0 Death due to MS

Expanded Disability Status Scale (EDSS) Detailed:

Score

Description

*FS = Functional Systems

0 Normal neurologic examination (all grade 0 in FS, cerebral grade 1 acceptable)
1.0 No disability, minimal signs in 1 FS (ie, grade 1 excluding cerebral grade 1)
1.5 No disability, minimal signs in more than 1 FS (more than 1 grade 1 excluding cerebral grade 1)
2.0 Minimal disability in 1 FS (1 FS grade 2, others 0 or 1)
2.5 Minimal disability in 2 FS (2 FS grade 2, others 0 or 1)
3.0 Moderate disability in 1 FS (1 FS grade 3, others 0 or 1) or mild disability in 3 or 4 FS (3/4 FS grade 2, others 0 or 1) though fully ambulatory
3.5 Fully ambulatory but with moderate disability in 1 FS (1 grade 3) and 1 or 2 FS grade 2, or 2 FS grade 3, or 5 FS grade 2 (others 0 or 1)
4.0 Fully ambulatory without aid; self-sufficient; up and about some 12 hours a day despite relatively severe disability, consisting of 1 FS grade 4 (others 0 or 1) or combinations of lesser grades exceeding limits of previous steps; able to walk approximately 500 m without aid or resting
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; characterized by relatively severe disability, usually consisting of 1 FS grade 4 (others 0 or 1) or combinations of lesser grades exceeding limits of previous steps; able to walk approximately 300 m without aid or rest
5.0 Ambulatory without aid or rest for approximately 200 m; disability severe enough to impair full daily activities (eg, to work full day without special provisions; usual FS equivalents are 1 grade 5 alone, others 0 or 1; or combinations of lesser grades usually exceeding specifications for step 4.0)
5.5 Ambulatory without aid or rest for approximately 100 m; disability severe enough to preclude full daily activities (usual FS equivalents are 1 grade 5 alone; others 0 or 1; or combinations of lesser grades usually exceeding those for step 4.0)
6.0 Intermittent or unilateral constant assistance (cane, crutch, or brace) required to walk approximately 100 m with or without resting (usual FS equivalents are combinations with more than 2 FS grade 3+)
6.5 Constant bilateral assistance (canes, crutches, or braces) required to walk approximately 20 m without resting (usual FS equivalents are combinations with more than 2 FS grade 3+)
7.0 Unable to walk beyond approximately 5 m even with aid; essentially restricted to wheelchair; wheels self in standard wheelchair and transfers alone; up and about approximately 12 hr/day (usual FS equivalents are combinations with more than 1 FS grade 4+; very rarely, pyramidal grade 5 alone)
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 1 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 much of the day; has some effective use of arms; retains some self-care functions (usual FS equivalents are combinations, generally 4+ in several systems)
9.0 Helpless bedridden patient; can communicate and eat (usual FS equivalents are combinations, mostly grade 4+)
9.5 Totally helpless bedridden patient; unable to communicate effectively or eat/swallow (usual FS equivalents are combinations, almost all grade 4+)
10.0 Death due to MS

Advantages of the EDSS are that it is widely used clinically, is easy to administer, and requires no special equipment.

EDSS Scale limitations:

It is heavily dependent on mobility
It is somewhat subjective in certain areas (eg, bowel and bladder function)
It is insensitive to small changes
It does not present an accurate picture of the patient’s cognitive abilities and functional abilities in performing activities of daily living (ADLs)
It is nonlinear in terms of the time spent at various ranges of the scale
Despite its limitations, the EDSS is often used as a standardization measure for clinical trials.

Calculating Your EDSS Numbers:

Barts and The London Neuroimmunology Group has created an online EDSS calculator and tool by which you can track your EDSS scoring and disability level

You can access it by clicking the button below.

Calculate Your EDSS Score – Click Here

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