How to Do the EDSS - c.ymcdn.com

1 How to Do the EDSSS tephen S. Kamin, MDNew Jersey Medical SchoolJohn F. Kurtzke, MD1926-2015 EDSS expanded disability status scale Devised by John Kurtzke in the 1960s and modified in the 1980sEDSS Advantages Widely used Provides a single number measure of disability Disadvantages Non-linear Bi-modal distribution Overemphasizes ambulation Minimizes cognition Limited inter-rater reliability Some ambiguitiesEDSSMS Impairment ScaleEDSS vs. MSISMS Severity ScoreEDSSN euroStatus A modification of the original Kurtzke scale by Kappos Eliminates some ambiguities In general use in clinical trials On-line training & certification Basis for this sessionNeuroStatusNeuroStatusEDSS Components Functional Systems Scores (FS) disability status Scores (DSS)Functional Systems Scores Visual Pyramidal Cerebellar Sensory Bowel and Bladder Cerebral OtherVisual 0- Normal 1- Disc pallor OR small scotoma OR better than 20/30 2- Worse eye 20/30 to 20/59 3- Large scotoma or moderate field defect ORWorse eye 20/60 to 20/99 4- Marked field defect ORWorse eye 20/100 to 20/200 ORWorse eye 20/60 to 20/99 and better eye < 20/60 Visual 5- Worse eye < 20/200 ORWorse eye 20/100 to 20/200 and better eye < 20/60 6- Worse eye < 20/200 ANDB etter eye < 20/60 Visual4 worse eye with marked decrease of fields and/or maximal visual acuity (corrected)of 20 / 100 to 20 / 200 ( );grade 3 plus maximal acuity of better eye of 20 / 60 ( ) or less5 worse eye with maximal visual acuity (corrected) less than 20 / 200 ( ).

2 Grade 4 plus maximal acuity of better eye of 20 / 60 ( ) or less6 grade 5 plus maximal visual acuity of better eye of 20 / 60 ( ) or lessVisionCorrected ScoresScoreCorrected score00112232435364 VisualWorse eyeBetter eyeFieldsScotomaPallor0020/2020/20 Absent11> 20/30 SmallPresent2220/30-20/593220/60-20/99 Moderate defectLarge4320/100-20/200 Complete hemi4320/60-20/99 AND 20/6053< 20/2005320/100-20/200 AND 20/6064< 20/200 AND 20/60 Question 1 The patient has a left homonymous hemianopsia. Visual acuity is 20/30 in the intact field of both 1 The Corrected Visual FSS is: A. 1 B. 2 C. 3 D. 4 Question 1 The Corrected Visual FSS is:123425%25%25%25% A. 1 B. 2 C. 3 D. 410 VisualWorse eyeBetter eyeFieldsScotomaPallor0020/2020/20 Absent11> 20/30 SmallPresent2220/30-20/593220/60-20/99 Moderate defectLarge4320/100-20/200 Complete hemi4320/60-20/99 AND 20/6053< 20/2005320/100-20/200 AND 20/6064< 20/200 AND 20/60 Question 2 There is disc pallor of the right eye.

3 The acuity is 20/20 2 The corrected visual FSS is: A. 0 B. 1 C. 2 Question 2 The corrected visual FSS is:12333%33%33% A. 0 B. 1 C. 2100of30 VisualWorse eyeBetter eyeFieldsScotomaPallor0020/2020/20 Absent11> 20/30 SmallPresent2220/30-20/593220/60-20/99 Moderate defectLarge4320/100-20/200 Complete hemi4320/60-20/99 AND 20/6053< 20/2005320/100-20/200 AND 20/6064< 20/200 AND 20/60 Question 3 The patient is blind in the left eye and has acuity of 20/100 in the right 3 The corrected visual FSS is: A. 3 B. 4 C. 5 D. 6 Question 3 The corrected visual FSS is: A. 3 B. 4 C. 5 D. 6 VisualWorse eyeBetter eyeFieldsScotomaPallor0020/2020/20 Absent11> 20/30 SmallPresent2220/30-20/593220/60-20/99 Moderate defectLarge4320/100-20/200 Complete hemi4320/60-20/99 AND 20/6053< 20/2005320/100-20/200 AND 20/6064< 20/200 AND 20/60 Brainstem 0-Normal 1- Signs only 2- Moderate nystagmus OR moderate EOM impairmentORother mild disabilityBrainstem 3- Severe nystagmusORMarked extraocular weakness ORModerate disability of other cranial nervesBrainstem 4- Marked dysarthria or other marked disability 5- Unable to swallow or speakBrainstemEOM 0-Normal 1- Signs only: subtle and patient without complaints 2- Mild: Subtle and patient aware ORobvious and incomplete but patient unaware 3- Moderate.

4 Obvious, incomplete and patient aware ORcomplete in one direction 4- Marked: Complete paralysis of >1 directionBrainstemNystagmus 0- None 1- Signs only or mild (only beyond 30 ) 2- Moderate: at 30 but not in primary position 3- Severe: in primary position or interfering with vision ORcomplete INO ORoscillopsiaBrainstemTrigeminal 0- None 1- Signs only 2- Mild: Detectible (patient aware) 3- Moderate: Impaired sharp/dull ORtrigeminal neuralgia in past 24 hours 4- Marked: No discrimination of sharp/dullBrainstemFacial 0- None 1- Signs only 2- Mild: Detectible, patient aware 3- Moderate: Incomplete eye closure or mouth closure with symptoms 4- Marked: Complete palsyBrainstemHearing 0-No loss 1- Signs only: Decreased finger rub ORlateralizing Weber, patient unaware 2- Mild: 1, but patient aware 3- Moderate: Absent finger rub ORimpaired word discrimination 4- Marked: Absent word discriminationBrainstemDysarthria 0- None 1- Signs only 2- Mild: Clinically detectible 3- Moderate: Impaired comprehensibility 4- Marked: Incomprehensible speech 5- Inability to speakBrainstemDysphagia 0- None 1- Signs only 2- Mild: Difficulty with liquids 3- Moderate: Difficulty with solids and liquids 4- Marked: Sustained difficulty, requires pureed diet 5- Unable to swallowBrainstemOther Cranial Nerves 0 Normal 1 Signs only 2 Mild.

5 Detectible, patient usually aware 3 Moderate 4 MarkedBrainstemScoreEOMN ystagmus CN VCN VII Hearing DysarthriaDysphagia01 Signs onlyOR MildSigns onlyOR MildSigns onlySigns onlySigns onlySigns onlySigns only2 ModModMildMildMildMildMild3 MarkedSevereModModModModMod4 MarkedMarked MarkedMarked Marked5 UnableUnableQuestion 4 The patient has abduction nystagmus of the left eye but does not complain of diplopia. There is mild loss of sensation on the left side of the face, of which she is not 4 The Brainstem FSS is: A. 1 B. 2 C. 3 D. 4 Question 4 The Brainstem FSS is:123425%25%25%25% A. 1 B. 2 C. 3 D. 410 BrainstemScore EOMN ystagmus CN VCN VIIH earing DysarthriaDysphagia01 Signs onlyOR MildSigns onlyOR MildSigns onlySigns onlySigns onlySigns onlySigns only2 ModModMildMildMildMildMild3 MarkedSevereModModModModMod4 Marked MarkedMarkedMarked Marked5 UnableUnableQuestion 5 The patient complains of diplopia on far rightward gaze but eye movements are not obviously impaired.

6 There is incomplete closure of the right eye and mild dysarthria which does not impair 5 The brainstem FSS is: A. 1 B. 2 C. 3 D. 4 Question 5 The brainstem FSS is:123425%25%25%25% A. 1 B. 2 C. 3 D. 410 BrainstemScore EOMN ystagmusCN VCN VIIH earing DysarthriaDysphagia01 Signs only OR MildSigns onlyOR MildSigns onlySigns onlySigns onlySigns onlySigns only2 ModModMildMildMildMildMild3 MarkedSevereModModModModMod4 Marked MarkedMarkedMarked Marked5 UnableUnableQuestion 6 The patient has speech which is difficult to understand. He complains of intermittent choking on both solids and liquids. There is nystagmus in all directions of gaze, but not in primary 6 The brainstem FSS is: A. 1 B. 2 C. 3 D. 4 Question 6 The brainstem FSS is:123425%25%25%25% A.

7 1 B. 2 C. 3 D. 410 BrainstemScore EOMN ystagmus CN VCN VIIH earing DysarthriaDysphagia01 Signs onlyOR MildSigns onlyOR MildSigns onlySigns onlySigns onlySigns onlySigns only2 ModModMildMildMildMildMild3 MarkedSevereModModModModMod4 Marked MarkedMarkedMarked Marked5 UnableUnablePyramidal 0-Normal 1- Abnormal signs only (hyperreflexia,Babinski sign) 2- Minimal disability - fatigability OR reduced performance OR 4/5 in one or 2 muscle groups 3- Mild to moderate paraparesis orhemiparesis (usually 4/5 in > 2 muscle groups)OR 3/5 in 1 or 2 muscle groupsOR severe monoparesis (< 2/5 in 1 group)Pyramidal 4- Marked paraparesis or hemiparesis or moderate quadriparesis 3/5 in 3 or 4 limbs 2/5 in 2 limbs 1/5 in 1 limb 5- Paraplegia, hemiplegia or marked quadriparesis < 2/5 in 3 or 4 limbs 1/5 in at least 2 limbs 6- QuadriplegiaPyramidal Problems Muscle groups versus limbs Best interpretation: muscle groups = limbs(see rating of 3) But NOT for rating of 2 Pyramidal1 limb2 limbs3 limbs4 limbs0 Normal1 Signs only24/532 or 3/53/54/54/540 or 1/52/53/53/550 or 1/52/52/560 or 1/5 Question 7 Strength is 4/5 in the right deltoids and right triceps.

8 All other muscle groups are 5 7 The Pyramidal FSS is: A. 2 B. 3 C. 4 D. 5 Question 7 The Pyramidal FSS is:123425%25%25%25% A. 2 B. 3 C. 4 D. 510 Pyramidal1 limb2 limbs3 limbs4 limbs0 Normal1 Signs only24/532 or 3/53/54/54/540 or 1/52/53/53/550 or 1/52/52/560 or 1/5 Question 8 Strength on the right is deltoids 3/5, biceps 4/5, triceps 3/5, wrist extensors 4/5, iliopsoas 2/5, hamstrings 3/5, anterior tibials 3/5. All other groups are 5 8 The Pyramidal FSS is: A. 2 B. 3 C. 4 D. 5 Question 8 The Pyramidal FSS is:123425%25%25%25% A. 2 B. 3 C. 4 D. 510 Pyramidal1 limb2 limbs3 limbs4 limbs0 Normal1 Signs only24/532 or 3/53/54/54/540 or 1/52/53/53/550 or 1/52/52/560 or 1/5 Question 9 The strength in the left arm is deltoid 3/5, triceps 4/5, wrist extensors 4/5.

9 In the legs iliopsoas are 2/5, hamstrings 3/5 and anterior tibials 2/5 bilaterally. All other muscle groups are at least 4/5. Question 9 The Pyramidal FSS is: A. 2 B. 3 C. 4 D. 5 Question 9 The Pyramidal FSS is:123425%25%25%25% A. 2 B. 3 C. 4 D. 510 Pyramidal1 limb2 limbs3 limbs4 limbs0 Normal1 Signs only24/532 or 3/53/54/54/540 or 1/52/53/53/550 or 1/52/52/560 or 1/5 Cerebellar 0 normal 1 abnormal signs without disability 2 mild ataxia OR moderate station ataxia (Romberg)OR unable to tandem 3 moderate limb ataxiaOR moderate or severe gait/truncal ataxia 4 severe gait/truncal ataxia AND severe ataxia in three or four limbs 5 unable to perform coordinated movements due to ataxia X pyramidal weakness (BMRC grade 3 or worse in limbstrength) or sensory deficit interferes with testingCerebellar X ratings Score the actual performance and add XCerebellar Limb ataxia 0 Normal 1 Signs only 2 Mild: Tremor or clumsiness easily seen, minor interference with function 3 Moderate.

10 Interference with function in all spheres 4 Severe: Most functions very difficultCerebellar Trunk 0 Normal 1 Signs only 2 Mild: Sway with eyes closed 3 Moderate: Sway with eyes open 4 Severe: Requires assistance to sitCerebellar Gait 0- Normal 1- Signs only 2- Mild: Balance problem recognized by patient or others 3- Moderate: Abnormal on ordinary walking 4- Severe: Unable to walk more than a few steps unassistedCerebellar Problems: Ambiguity of trunk/gait Use of Romberg for cerebellar testingCerebellarLimbTrunk/StanceGait0 NormalNormal1 Signs onlySigns onlySigns only2 MildPositive RombergUnable to tandem3 ModerateModerate/severeModerate/severe4 Severe (3-4 limbs)AND SevereAND Severe5 Action impossibleXWeakness interferesQuestion 10 The patient has bilateral intention tremor and has difficulty using eating utensils or buttoning clothes.