EDSS

The EDSS scale ranges from 0 to 10 in 0.5 unit increments that represent higher levels of disability.

Eight functional systems (FS):

• pyramidal – muscle weakness or difficulty moving limbs
• cerebellar – ataxia, loss of balance, coordination or tremor
• brainstem – problems with speech, swallowing and nystagmus
• sensory – numbness or loss of sensations
• bowel and bladder function
• visual function - problems with sight
• cerebral functions - problems with thinking and memory
• other

A functional system (FS) represents a network of neurons in the brain with responsibility for particular tasks. Each FS is scored on a scale of 0 (no disability) to 5 or 6 (more severe disability).

• EDSS steps 1.0 to 4.5 refer to people with MS who are able to walk without any aid.
• EDSS steps 5.0 to 9.5 are defined by the impairment to walking.

---

• 0.0: Normal Neurological Exam
• 1.0: No disability, minimal signs in 1 FS
• 1.5: No disability, minimal signs in more than 1 FS
• 2.0: Minimal disability in 1 FS
• 2.5: Mild disability in 1 or Minimal disability in 2 FS
• 3.0: Moderate disability in 1 FS or mild disability in 3 - 4 FS, though fully ambulatory
• 3.5: Fully ambulatory but with moderate disability in 1 FS and mild disability in 1 or 2 FS; or moderate disability in 2 FS; or mild disability in 5 FS
• 4.0: Fully ambulatory without aid, up and about 12hrs a day despite relatively severe disability. Able to walk without aid 500 meters
• 4.5: Fully ambulatory without aid, up and about much of day, able to work a full day, may otherwise have some limitations of full activity or require minimal assistance. Relatively severe disability. Able to walk without aid 300 meters
• 5.0: Ambulatory without aid for about 200 meters. Disability impairs full daily activities
• 5.5: Ambulatory for 100 meters, disability precludes full daily activities
• 6.0: Intermittent or unilateral constant assistance (cane, crutch or brace) required to walk 100 meters with or without resting
• 6.5: Constant bilateral support (cane, crutch or braces) required to walk 20 meters without resting
• 7.0: Unable to walk beyond 5 meters even with aid, essentially restricted to wheelchair, wheels self, transfers alone; active in wheelchair about 12 hours a day
• 7.5: Unable to take more than a few steps, restricted to wheelchair, may need aid to transfer; wheels self, but may require motorized chair for full day's activities
• 8.0: Essentially restricted to bed, chair, or wheelchair, but may be out of bed much of day; retains self care functions, generally effective use of arms
• 8.5: Essentially restricted to bed much of day, some effective use of arms, retains some self care functions
• 9.0: Helpless bed patient, can communicate and eat
• 9.5: Unable to communicate effectively or eat/swallow
• 10.0: Death due to MS