Expanded Disability Status Scale

(EDSS)
The Expanded Disability Status Scale (EDSS) is a method of quantifying disability in multiple sclerosis and
monitoring changes in the level of disability over time. It is widely used in clinical trials and in the assessment
of people with MS.
The scale was developed by a neurologist called John Kurtzke in 1983 as an advance from his previous 10
step Disability Status Scale (DSS).
The EDSS scale ranges from 0 to 10 in 0.5 unit increments that represent higher levels of disability. Scoring is
based on an examination by a neurologist.
EDSS steps 1.0 to 4.5 refer to people with MS who are able to walk without any aid and is based on measures
of impairment in eight functional systems (FS):
pyramidal - weakness or difficulty moving limbs

cerebellar - ataxia, loss of coordination or tremor

brainstem - problems with speech, swallowing and nystagmus
sensory - numbness or loss of sensations

bowel and bladder function

visual function
cerebral (or mental) functions
other
Each functional system is scored on a scale of 0 (no disability) to 5 or 6 (more severe disability).
EDSS steps 5.0 to 9.5 are defined by the impairment to walking. The scale is sometimes criticised for its
reliance on walking as the main measure of disability.
Although the scale takes account of the disability associated with advanced MS, most people will never reach
these scores. A large study that looked at people with MS at a clinic in Ontario (prior to the development of
the expanded version) found that 51% of people had a DSS score of 5 or lower. 88% had a score of 7 or lower.

Expanded Disability Status Scale (EDSS)

Scor
e
1.0
1.5
2.0
2.5
3.0
3.5
4.0
4.5
5.0

Description
No disability, minimal signs in one FS
No disability, minimal signs in more than one FS
Minimal disability in one FS
Mild disability in one FS or minimal disability in two FS
Moderate disability in one FS, or mild disability in three or four FS. No
impairment to walking
Moderate disability in one FS and more than minimal disability in several
others. No impairment to walking
Significant disability but self-sufficient and up and about some 12 hours a
day. Able to walk without aid or rest for 500m
Significant disability but 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. Able to walk without aid or rest for 300m
Disability severe enough to impair full daily activities and ability to work a
full day without special provisions. Able to walk without aid or rest for 200m

Scor
Description
e
Disability severe enough to preclude full daily activities. Able to walk
5.5
without aid or rest for 100m
Requires a walking aid - cane, crutch, etc - to walk about 100m with or
6.0
without resting
Requires two walking aids - pair of canes, crutches, etc - to walk about 20m
6.5
without resting
Unable to walk beyond approximately 5m even with aid. Essentially
7.0 restricted to wheelchair; though wheels self in standard wheelchair and
transfers alone. Up and about in wheelchair some 12 hours a day
Unable to take more than a few steps. Restricted to wheelchair and may
7.5 need aid in transfering. Can wheel self but can not carry on in standard
wheelchair for a full day and may require a motorised wheelchair
Essentially restricted to bed or chair or pushed in wheelchair. May be out of
8.0 bed itself much of the day. Retains many self-care functions. Generally has
effective use of arms
Essentially restricted to bed much of day. Has some effective use of arms
8.5
retains some self care functions
9.0 Confined to bed. Can still communicate and eat
Confined to bed and totally dependent. Unable to communicate effectively
9.5
or eat/swallow
10.0 Death due to MS

References
Kurtzke JF.
Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS).
Neurology 1983;33(11):1444-1452.
abstract
Weinshenker BG, et al.
The natural history of multiple sclerosis: a geographically based study. 1 Clinical course and disability.
Brain 1989;112:133-146.
abstract
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