How do we evaluate EDSS if the patient has dicreassed vision in one eye not due to MS?If the deficit is not due to MS it is noted in the NS forms and in your files but not graded. It does not contribute to the grading for Functional systems and EDSS.
Also, how do we evaluate EDSS if patient has tremor not due to MS - do we indicate this tremor in the neurostatus form?
The EDSS definitions document I have (version 04/07) does not use the term "restriction" anywhere yet the scoring sheet has boxes both for ">/= 500 meters but not unrestricted" and "unrestricted". Yes. the EDSS definitions document (version 04/07) does not use the term "restriction" and the scoring sheet has boxes for ">/= 500 meters but not unrestricted" an for "unrestricted".
Are both of these scoring options considered "fully ambulatory" where the other FS determine the EDSS Step? Is the scoring logic below correct?
EDSS 0-1.5 = "Unrestricted" on scoring sheet with other FS determining exact score
EDSS 2.0-4.0 (inclusive) = “Unrestricted” or ">/= 500 meters but not unrestricted" on scoring sheet with other FS determining the exact score
EDSS 4.5 and above = not able to walk at least 500 meters without aid or rest with actual distance under 500 meters and other FS determining the exact score
Please be aware that the term "fully ambulatory" is not synonymous with "unrestricted". "Fully ambulatory" means at least 500 meters of ambulation, but NOT unristricted, which would mean the patient is able to walk a distance that is regarded as normal, compared with healthy individuals of similar age.
If the walking distance is not unrestricted, but at least 500 meters are possible, the EDSS could be anything above or equal to EDSS 2 (the EDSS score then is determined only by the FS scores). Therefore at least the pyramidal or cerebellar FS must be =/> 2 to explain the "restriction" of ambulation.
An EDSS from 0 up to 1.5 requires an "unrestricted" in ambulation.
If the walking distance is below 500 meters, the EDSS must be above EDSS 4, depending to the ranges provided in the Manual (>100, 200, >300). For example, if the walking distance would be 450m, then the EDSS will be at least 4.5.
What are some examples of bilateral assistance?The following list contains examples of bilateral assistance.- Walker- Assistance by another person- Bilateral crutches- Bilateral canes- Bilateral sticks
If a patient can walk more than 500 meters, his/her EDSS step is determined solely by FS scores.Yes, if patient walks without aid or rest
If a patient is able to walk more than 300 but less than 500 meters, EDSS score is at least 4.5 (or higher depending on FS scores).Yes, if patient walks without aid or rest
If a patient complaints of fatigability but still is able to walk more than 500 meters his/her EDSS step is at least 2.0 (determined by Pyramidal FS score)If ambulation is not unrestricted, but equal or more than 500 m, EDSS is at least 2.
But it is still hard to imagine a situation when EDSS of 4.0 is determined solely by patient's ambulation. Does that mean that EDSS step of 4.0 can only be determined by FS scores as well as steps up to 3.5?Yes. For EDSS ranging from 2 to 4 you need at least a walking distance of equal/more than 500 m (unrestricted or not unrestricted, patient walks without aid or rest). For EDSS ranging from 0 to 1.5 the walking distance must be unrestricted.
The combination of FS scores exceeds the requirements for an EDSS step of 5.0 (one FS score 5, but the other FS scores are not all 0 or 1). The patient is able to walk for more than 500 meters without rest or assistance. What is the EDSS step?For example, the FS scores are:
- Visual: 1
- Brainstem: 2
- Pyramidal: 3
- Cerebellar: 2
- Sensory: 1
- Bowel and Bladder: 5 (converted)
- Cerebral: 0
- Fully Ambulatory
The EDSS step is 5.0. The note on the top of page 10 states that EDSS steps 5.5 to 8.0 are exclusively defined by the ability to ambulate or to use a wheelchair. The definition for EDSS step 5.5 does not include FS scores, nor does it contain the clause in its definition, ìcombination of lesser grades exceeding limits of previous step.
If a patient is able to walk more than 500 meters without assistance, can he still have an EDSS step of 4.5?Yes. A patient can have an EDSS step of 4.5 as long as the individual FS scores meet the criteria for that step, even if the patient is still able to walk more than 500 meters unassisted. EDSS steps between 4.0 and 5.0 are defined by both the FS scores and the walking range. In general, the more severe parameter determines the EDSS step.