Public forum - Last update 14.12.2015
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14.12.2015 - Topic: Visual (optic) Functions

Could you please clarify the difference between FS 5 and 6 in visual functions?


To score an FS of 5 you either have;
- one eye with a visual acuity less than 20/200 (0.1) and the other more than 20/60 (0.33).
- alternatively one eye fulfilling the definition of FS 4 plus acuity of the "better" eye of 20/60 (0.33) or less.

To score an FS of 6 you would need;
- one eye as it is described in the "first" definition of FS 5
- but the other ("better") eye must be 20/60 (0.33) or less.


06.02.2015 - Topic: Cerebellar Functions

I have a patient with moderate hemiparesis (pyramidal score 3) who is unable to tandem walk because of weakness, but does not appear ataxic. How would I score tandem walk and the EDSS step in the Cerebellar category?


If there are no other signs of ataxia you should score a 2 for Tandem walk and for the cerebellar FS score a 2X
X indicates problems with cerebellar scoring due to interfering paresis


26.08.2014 - Topic: Brainstem Functions

What would an isolated bilateral internuclear ophthalmoplegia score?


A unilateral complete internuclear ophthtalmoplegia (INO) would result in a brainstem FS 3, actually because of sustained nystagmus. You cannot get a higher FS score if there is only extraocular movement impairment or nystagmus, so a bilateral INO still scores a 3.


26.08.2014 - Topic: Sensory Functions

If a person has absent vibration sense in both toes but present in both ankles, this would presumably score a 3 (marked - complete loss). But what would it score on the FSS? A 1 (mild decrease in one or two limbs) or a 3 ("essentially lost vibration in one or two limbs") - ie does the FSS score refer to distal loss or overall limb loss?


The FS score refers to distal loss of vibration sense, so in this case it would be a 3, because of marked reduction of vibration in two limbs.


15.08.2014 - Topic: General requests

What are the requirements for performing EDSS? Does the investigator have to be a neurologist or can they just be a physician not specialised in neurology? Can nurses perfom EDSS?


We strongly recommend that EDSS is performed by a neurologist or a neurologist in training. For certain studies other requirements may be defined by the sponsor.


15.08.2014 - Topic: Ambulation

In a prior question (under the Ambulation section in the public forum) with a person who needed to touch the wall AFTER walking 110 meters and then completing the total of 500 meters, without further aid or rest, you suggested the EDSS is 5.5. Did he not also walk 390 meters without assistance for an EDSS of 4.5? The question I also raise is, if a person has two performances, do you score the better or worse one?

Also, the exceptions to the Ambulation Functional Score section indicate that unilateral assistance walking >= 50 meters is an EDSS of 6.0, while < 50 meters is 6.5. But the main text indicates that 100 meters is the cut-off for 6.0.

Also, the exceptions to the Ambulation Functional Score section indicate that bilateral assistance walking >= 120 meters is an EDSS of 6.0, while < 10-120 meters is 6.5. But the main text indicates that "at least 20 meters" is the cut-off for 6.5.

Could you clarify the discrepancy in the numbers?


Thank you for this remark.

Indeed, always the patient's best performance should be rated, so in this case EDSS should be 4.5 as the patient was able to walk 390 metres. One could argue that the reater should have encouraged the patient to complete the "second" 500 metres to determine the walking range correctly.

Regarding your second point we are well aware of the discrepancy caused by the introduction of the Ambulation Score. This was done in the first place to increase the consistency in determination of the walking range with assistance. As long as this discrepancy is not resolved, we strongly recommend to use only the definitions under the Ambulation Score section to calculate EDSS scores of 6.0 and 6.5.


15.08.2014 - Topic: Pyramidal Functions

During assessment of Pyramidal FS patient reported heavy leg while going/ running upstairs. That was remarkable for patient because he could not run upstairs as fast as before after his children while playing. Assessment of BMRC was 5 in all muscle groups. What pyramidal FS score I could give for this patient?


In this case you should rate the patient's overall motor performance as abnormal (1) due to reduced performance in strenous motor tasks without reduction in limb strength on confrontional testing. This results in a pyramidal FS score of 2.


15.08.2014 - Topic: Ambulation

On history if patient discloses that her day-day activity needs bilateral assistance, for eg, going out shopping she needs a walker or holds on to a trolley, in the house holds on to the wall and furnitures...This patient can still walk 200mts unaided with a waddling slow gait, what is her EDSS?


To determine the ambulation score you have to rate the patient's best possible performance. So ambulation score in this case is 3 resulting in an EDSS score of 5.0, even if she uses a walker in everyday life.


15.08.2014 - Topic: Ambulation

How to determine the unrestricted walking depending on age and phisical state. For example if patient replies that he can walk 5000 metrs - is it enough for "unrestricted walking", or he has to walk more than 5000m. Are there recomendations?


If the patient is reliable and you consider 5000 metres as normal, compared with healthy individuals of similar age and physical condition you can rate ambulation as "unrestricted". You do not have to make the patient walk more then 5000 metres.


15.08.2014 - Topic: Pyramidal Functions

In determining the score for the pyramidal system, what constitutes a "muscle group?" Is it the all the muscles that serve to bend a single joint in one direction, is it the muscles on both sides of the body that do the same thing, is it all the extensor (or all of the flexor) muscles in one particular extremity, or is it something else?


A muscle group is defined as all mucles that serve to bend a single joint in one direction, e.g. the knee flexors (M. biceps femoris, M. semitendinosus, M. semimembranosus, M. sartorius and M. gastrocnemius).