Version May 2024
| Functional systems (FS) |
| Pyramidal functions |
| 0. Normal |
| 1. Abnormal signs without disability |
| 2. Minimal disability |
| 3. Mild or moderate paraparesis or hemiparesis; severe monoparesis |
| 4. Marked paraparesis or hemiparesis; moderate quadriparesis; or monoplegia |
| 5. Paraplegia, hemiplegia, or marked quadriparesis |
| 6. Quadriplegia |
| V. Unknown |
| Cerebellar functions |
| 0. Normal |
| 1. Abnormal signs without disability |
| 2. Mild ataxia |
| 3. Moderate truncal or limb ataxia |
| 4. Severe ataxia, all limbs |
| 5. Unable to perform coordinated movements due to ataxia |
| V. Unknown |
| X. Is used throughout after each number when weakness (grade 3 or more on pyramidal) interferes with testing |
| Brain stem functions |
| 0. Normal |
| 1. Signs only |
| 2. Moderate nystagmus or other mild disability |
| 3. Severe nystagmus, marked extraocular weakness, or moderate disability of other cranial nerves |
| 4. Marked dysarthria or other marked disability |
| 5. Inability to swallow or speak |
| V. Unknown |
| Sensory functions |
| 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 essentially lost 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 (essentially) 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 |
| V. Unknown |
| Bowel and bladder functions |
| 0. Normal |
| 1. Mild urinary hesitancy, urgency, or retention |
| 2. Moderate hesitancy, urgency, retention of bowel or bladder, or rare urinary incontinence |
| 3. Frequent urinary incontinence |
| 4. In need of almost constant catheterization |
| 5. Loss of bladder function |
| 6. Loss of bowel and bladder function |
| V. Unknown |
| Visual (or optic) functions |
| 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 to 20/59 |
| 3. Worse eye with large scotoma, or moderate decrease in fields, but with maximal visual acuity (corrected) of 20/60 to 20/99 |
| 4. Worse eye with marked decrease of fields and maximal visual acuity (corrected) of 20/100 to 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 |
| V. Unknown |
| X. Is added to grades 0 to 6 for presence of temporal pallor |
| Cerebral (or mental) functions |
| 0. Normal |
| 1. Mood alteration only (Does not affect Disability Status Scale 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 |
| V. Unknown |
| Other functions |
| 0. None |
| 1. Any other neurologic findings attributed to MS (specify) |
| V. Unknown |
| Expanded Disability Status Scale (EDSS) |
| 0 = Normal neurologic exam (all grade 0 in Functional Systems [FS]; Cerebral grade 1 acceptable) |
| 1.0 = No disability, minimal signs in one FS (ie, grade 1 excluding Cerebral grade 1) |
| 1.5 = No disability minimal signs in more than one FS (more than one grade 1 excluding Cerebral 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 or 1) |
| 3.0 = Moderate disability in one FS (one FS grade 3, others 0 or 1), or mild disability in three or four FS (three/four FS grade 2, others 0 or 1) though fully ambulatory |
| 3.5 = Fully ambulatory but with moderate disability in one FS (one grade 3) and one or two FS grade 2; or two FS grade 3; or five 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 one FS grade 4 (others 0 or 1, or combinations of lesser grades exceeding limits of previous steps. Able to walk without aid or rest some 500 meters. |
| 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 one FS grade 4 (others 0 or 1) or combinations of lesser grades exceeding limits of previous steps. Able to walk without aid or rest for some 300 meters. |
| 5.0 = Ambulatory without aid or rest for about 200 meters; disability severe enough to impair full daily activities (eg, to work 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 or rest for about 100 meters; disability severe enough to preclude full daily activities. (Usual FS equivalents are one 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 about 100 meters with or without resting. (Usual FS equivalents are combinations with more than two FS grade 3+.) |
| 6.5 = Constant bilateral assistance (canes, crutches, or braces) required to walk about 20 meters without resting. (Usual FS equivalents are combinations with more than two FS grade 3+.) |
| 7.0 = Unable to walk beyond about 5 meters even with aid, essentially restricted to wheelchair; wheels self in standard wheelchair and transfers alone; up and about in wheelchair 12 hours a day. (Usual FS equivalents are combinations with more than one 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 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 much of the day; has some effective use of arm(s); retains some self-care functions. (Usual FS equivalents are combinations, generally 4+ in several systems.) |
| 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 = Death due to MS |
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