Based on the findings, a patient may be rated according to several clinical scales. The most widely accepted clinical rating scale is the 10-point Kurtzke Expanded Disability Status Scale, developed originally in 1955 as the Disability Status Scale, which is as follows:
o Grade 0 - Normal neurologic examination (all grade 0 in FS, cerebral grade 1 acceptable)
o Grade 1.0 - No disability, minimal signs in 1 FS (ie, grade 1 excluding cerebral grade 1)
o Grade 1.5 - No disability, minimal signs in more than 1 FS (more than 1 grade 1 excluding cerebral grade 1)
o Grade 2.0 - Minimal disability in 1 FS (1 FS grade 2, others 0 or 1)
o Grade 2.5 - Minimal disability in 2 FS (2 FS grade 2, others 0 or 1)
o Grade 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
o Grade 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)
o Grade 4.0 - Fully ambulatory without aid; self-sufficient; up and about some 12 h/d 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 without aid or rest approximately 500 m
o Grade 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 pzrovisions; usual FS equivalents are 1 grade 5 alone, others 0 or 1; or combinations of lesser grades usually exceeding specifications for step 4.0)
o Grade 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)
o Grade 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+)
o Grade 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+)
o Grade 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 h/d (usual FS equivalents are combinations with more than 1 FS grade 4+; very rarely, pyramidal grade 5 alone)
o Grade 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+)
o Grade 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)
o Grade 9.0 - Helpless bed patient; can communicate and eat (usual FS equivalents are combinations, mostly grade 4+)
o Grade 9.5 - Totally helpless bed patient; unable to communicate effectively or eat/swallow (usual FS equivalents are combinations, almost all grade 4+)
o Grade 10.0 - Death due to MS
The scale ranges from 0-10 in 0.5 increments. The scores from grades 0-4 are derived from Functional System (FS) scales that evaluate dysfunction in 8 neurologic systems, including pyramidal, cerebellar, brainstem, sensory, bladder and bowel, vision, cerebral, and "other."
o Limitations of the Expanded Disability Status Scale are that it (1) is heavily dependent on mobility; (2) is somewhat subjective in certain areas (eg, bowel and bladder function); (3) is insensitive to small changes; and (4) does not present an accurate picture of the patient's cognitive abilities and functional abilities in performing activities of daily living (ADL).
• Additional useful scales include the Ambulation Index, which is based solely on the ability to walk 25 feet, and the Scripps Neurologic Rating Scale, developed by Sipe in 1984. Both environmental factors and a genetic predisposition, which affect an individual's chance of acquiring the disease, appear to play a role.
If an individual lives in an area with low incidence of MS until age 15 years, that person's risk is low; however, if an individual lives in an area with a high incidence until age 15 years, the risk of developing MS is high. Certain ethnic groups (eg, Eskimos), despite living in areas of higher incidence, do not have high incidence of MS. Treatment
o Grade 0 - Normal neurologic examination (all grade 0 in FS, cerebral grade 1 acceptable)
o Grade 1.0 - No disability, minimal signs in 1 FS (ie, grade 1 excluding cerebral grade 1)
o Grade 1.5 - No disability, minimal signs in more than 1 FS (more than 1 grade 1 excluding cerebral grade 1)
o Grade 2.0 - Minimal disability in 1 FS (1 FS grade 2, others 0 or 1)
o Grade 2.5 - Minimal disability in 2 FS (2 FS grade 2, others 0 or 1)
o Grade 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
o Grade 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)
o Grade 4.0 - Fully ambulatory without aid; self-sufficient; up and about some 12 h/d 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 without aid or rest approximately 500 m
o Grade 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 pzrovisions; usual FS equivalents are 1 grade 5 alone, others 0 or 1; or combinations of lesser grades usually exceeding specifications for step 4.0)
o Grade 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)
o Grade 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+)
o Grade 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+)
o Grade 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 h/d (usual FS equivalents are combinations with more than 1 FS grade 4+; very rarely, pyramidal grade 5 alone)
o Grade 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+)
o Grade 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)
o Grade 9.0 - Helpless bed patient; can communicate and eat (usual FS equivalents are combinations, mostly grade 4+)
o Grade 9.5 - Totally helpless bed patient; unable to communicate effectively or eat/swallow (usual FS equivalents are combinations, almost all grade 4+)
o Grade 10.0 - Death due to MS
The scale ranges from 0-10 in 0.5 increments. The scores from grades 0-4 are derived from Functional System (FS) scales that evaluate dysfunction in 8 neurologic systems, including pyramidal, cerebellar, brainstem, sensory, bladder and bowel, vision, cerebral, and "other."
o Limitations of the Expanded Disability Status Scale are that it (1) is heavily dependent on mobility; (2) is somewhat subjective in certain areas (eg, bowel and bladder function); (3) is insensitive to small changes; and (4) does not present an accurate picture of the patient's cognitive abilities and functional abilities in performing activities of daily living (ADL).
• Additional useful scales include the Ambulation Index, which is based solely on the ability to walk 25 feet, and the Scripps Neurologic Rating Scale, developed by Sipe in 1984. Both environmental factors and a genetic predisposition, which affect an individual's chance of acquiring the disease, appear to play a role.
If an individual lives in an area with low incidence of MS until age 15 years, that person's risk is low; however, if an individual lives in an area with a high incidence until age 15 years, the risk of developing MS is high. Certain ethnic groups (eg, Eskimos), despite living in areas of higher incidence, do not have high incidence of MS. Treatment
