Functional Systems

The EDSS is based upon Neurological testing of Functional Systems (CNS areas regulating body functions): Pyramidal (ability to walk), Cerebellar (Coordination), BrainStem (Speech and Swallowing), Sensory (Touch and Pain), Bowel and Bladder; Visual; Mental; and "Other" (includes any other Neurological findings due to Multiple Sclerosis).

Each Functional System (FS) is graded to the nearest possible grade, and V indicates an unknown abnormality; these are not additive scores and are only used for comparison of individual items.

1. Pyramidal Function
   0 - Normal
   1 - Abnormal Signs without Disability
   2 - Minimal disability
   3 - Mild/Moderate ParaParesis of HemiParesis; Severe MonoParesis
   4 - Marked ParaParesis or HemiParesis; Moderate QuadraParesis or MonoParesis
   5 - Paraplegia, Hemiplegia, or Marked ParaParesis
   6 - Quadriplegia
   V - Unknown

2. Cerebellar Function
   0 - Normal
   1 - Abnormal Signs without disability
   2 - Mild Ataxia
   3 - Moderate Truncal or Limb Ataxia
   4 - Severe Ataxia
   5 - Unable to perform Coordinated Movements
   V - Unknown
   X - Weakness

3. BrainStem Function
   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 Speak or Swallow
   V - Unknown

4. Sensory Function
   0 - Normal
   1 - Vibration or Figure - Writing decrease only, in 1 or 2 limbs
   2 - Mild decrease in Touch or Pain or Position Sense, and/or moderate decrease in Vibration in 1 or 2 limb, or Vibration in 3 or 4 limbs
   3 - Moderate decrease in Touch or Pain or Proprioception, and/or essentially lost Vibration in 1 or 2 limbs; or mild decrease in Touch or Pain and/or moderate decrease in all Proprioceptive tests in 3 or 4 limbs
   4 - Marked decrease in Touch or Pain or loss of Proprioception, alone or combined in 1 or 2 limbs; or moderate decrease in Touch or Pain and/or severe Proprioceptive decrease in more than two limbs
   5 - Loss of Sensation in 1 or 2 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

5. Bowel and Bladder Function
   0 - Normal
   1 - Mild Urinary Hesitancy, Urgency, or Retention
   2 - Moderate Hesitancy, Urgency, or Retention of Bowel or Bladder, or rare Urinary InContinence
   3 - Frequent Urinary InContinence
   4 - Almost constant Cathaterization.
   5 - Loss of Bladder function
   6 - Loss of Bowel function
   V - Unknown

6. Visual Function
   0 - Normal
   1 - Scotoma with Visual Acuity > 20/30 (corrected)
   2 - Worse Eye with Scotoma with maximal Acuity 20/30 to 20/59
   3 - Worse Eye with large Scotoma or decrease in fields, Acuity 20/60 to 20/99
   4 - Marked decrease in fields, Acuity 20/100 to 20/200; grade 3 plus maximal Acuity of better Eye < 20/60
   5 - Worse Eye Acuity < 20/200; grade 4 plus better Eye Acuity < 20/60
   V - Unknown

7. Cerebral Function
   0 - Normal
   1 - Mood alteration
   2 - Mild decrease in Mentation
   3 - Moderate decrease in Mentation
   4 - Marked decrease in Mentation
   5 - Dementia
   V - Unknown

8. Other Function
   0 - Normal
   1 - Other Neurological finding