Functional Systems

Kurtzke, Neurology, 1983, 33:1444-52

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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.

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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


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


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


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


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


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


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


Other Function
0 - Normal
1 - Other Neurological finding

http://www.thjuland.net/edss-fs.html#Pyramidal