Latest contributions

Visual (4)
Brainstem (2)
Pyramidal (6)
Cerebellar (1)
Sensory (5)
Bowel and bladder (0)
Cerebral (4)
Ambulation (11)
Edss (9)

General requests (2)
Training DVD-ROM (0)

More about Neurostatus
and EDSS

During assessment of Pyramidal FS patient reported heavy leg while going/ running upstairs. That was remarkable for this 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 could I give for this patient?

Your patient complained of reduced motor performance. If there is no other good explanation (arthrosis? knee pain? etc.) you must asssume that this is due to MS and score a 2 in the pyramidal FS score (according to motor fatigability or reduced performens in strenuous motor tasks) and and 1 in the Overall motor performance subscore.

The patient states that she occasionally has left arm heaviness that occurs about once every few months. THe heavyness goes away on its own and the patient is able to work through it. It lasts about one day. However on motor testing Dr. KHoury finds that the patient is 5/5 strength in all 4 extremities and in all muscles tested. Should the score be a 0 for pyramidal functions or a 2 based on the minimal disablity she reports?

If such weakness does not persist and is neither detectable in the neurological examination nor reported by patient as present on the day of the visit, it won't count for the FS and EDSS. So in your specific case where there is no deficit in limb strength and no reported persisted reduction in strenuous motor tasks, the Pyramidal FS would be 0 (or 1 if there would be any reflex abnormalities etc.).

The manual says, "If the walking distance is < 500 meters, the EDSS step must be >= 4, depending on the ranges provided in part 10 of this manual (> 100, > 200, > 300)." In which circumstance would the EDSS be exactly 4.0? A walking distance lower than 500 meters should not correspond to an EDSS below 4.5, should it?

If the walking distance is below 500m the EDSS is 4,5 or 5,0 depending on the FS-Sores; if walking distance is below 300m the EDSS is 5,0 (independent from the FS-Scores); if the walking distance is below 200 the EDSS is 5,5 and in rare cases with an ambulation below 100m without assistance, the EDSS is 6,0. Otherwise with using an assistance, the EDSS is 6,0 or 6,5, depending on the type of assistance required when walking and the walking range. An EDSS of 4 you receive if walking distance is at least 500m (otherwise EDSS would be 4,5 or worse) and the combination of FS fulfill the criteria of EDSS 4 (see last page of booklet). Please be aware, with fully ambulatory you can get any EDSS between 2 and 5, depending on the FS-combinations. With an unrestricted walking distance the EDSS range would be (theoretical) between 0 and 5.

By which criteria, the EDSS is defined in patients with no unrestricted ambulation with a walking distance above 500 meters? For an EDSS step of 4.0, a lower limit for the walking distance is given with 500 meters, but no upper limit, where lower EDSS steps would apply? What criteria define the EDSS in patients with a walking distance of 800, 1200 or 3000 meters?

For any walking distance equal or above 500m (but not unrestricted) which is defined as "fully ambulatory", the EDSS step can be anything between 2.0 and 5.0, depending on the FS scores. The criteria, next to the observed walking for a minimum distance of 500 meters is the maximal unassisted walking distance reported by the patient. The upper limit is any walking distance below unrestricted (which means the patient is able to walk a distance without assistance that is regarded as normal, compared with healthy individuals of similar age and physical condition).

Am I right to understand that the outcome for the cerebellar FS is either 0, 1, 2, 3, 4, 5 and that in addition, the rater can add an X to these scores?

The X should be placed after the FS-Score only if weakness interferes with the testing of ataxia, usually when muscle groups are BMRC grade 3 or less in a limb showing ataxia. Please be aware that the X should not further be placed behind the EDSS-Step. The X is only for documentation of the possible role of weakness (and or severe sensory deficits) when testing cerebellar functions.

Also, the manual says, "If the walking
distance is < 500 meters, the EDSS step must be >= 4, depending on the ranges provided in part 10 of this manual (> 100, > 200, > 300)." In which circumstance would the EDSS be exactly 4.0? A walking distance lower than 500 meters should not correspond to an EDSS below 4.5, should it?

An EDSS of 4 you receive if walking distance is at least 500m (otherwise EDSS would be 4,5 or worse) and the combination of FS fulfill the criteria of EDSS 4 (see last page of booklet).
Please be aware, with fully ambulatory you can get any EDSS between 2 and 5, depending on the FS-combinations. With an unrestricted walking distance the range would be (theoretical) between 0 and 5.

Does the oscilation of lower extremities contribute to pyramidal FSS?

If you mean with "oscilation of lower extremities" intermittent fluctuation of muscle strength, please use the result of the examination of scheduled visit, if motor-fatigability is reported it contributes to the Pyramidal-FS at least with a score of 2.

EDSS score of patient who can walk 80 m without help is 6,0?

Concerning the walking distance the EDSS is 6.0 if the walking range < 100 meters without assistance. Please be aware that if an assistance is needed, for an EDSS of 6.0 you would require for the use of an unilateral assistance at least 50 m, for the use of a bilateral assistance at least 120m at minimum.

The EDSS Guidelines state that the visual acuity should be assessed using the best available correction. To be absolutely clear on this, should a pinhole be used when assessing visual acuity on EVERY patient, regardless of whether or not they normally wear spectacles.

No, the pinhole is only a possibility to cope with the situation if someone has no spectacles although he/she might need them. If you are in doubt you can simply test if acuity improves with the pin hole. If not you don't need to use it any more.

When testing visual acuity, should a pin-hole be used at each visit on a patient who does not normally wear spectacles, or could this mask any deterioration in vision

The pinhole is an incomplete substitute for correction of "non ms/non neurological " refraction problems for those patients who have forgotten their correction glasses or are not aware of the refraction problem and can be used as long as no adequate glasses are available. Using a pinhole should not impact on optic neuritis related visual deficits.

© 2007 | Impressum | Legal note | Contact | About | Help/FAQ