0: Normal

1: Abnormal signs without disability

2: Minimal disability

3: Mild or moderate paraparesis or hemiparesis; severe monoparesis

4: Marked paraparesis; or hemiparesis; or moderate quadriparesis; or monoplegia

5: Paraplegia, hemiplegia, or marked quadriparesis

6: Quadriplegia

0: Normal.

1: Abnormal signs without disability

2: Mild ataxia

3: Moderate truncal or limb ataxia

4: Severe ataxia, all limbs

5: Unable to perform coordinated movements due to ataxia

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 swallow or speak

0: Normal

1: Vibration or figure-writing decrease only, in 1-2 limbs

2: Mild decrease in touch, pain or position sense, and/or moderate decrease in vibration in 1-2 limbs; or vibratory decrease alone in 3-4 limbs

3: Moderate decrease in touch, pain or position sense, and/or lost vibration in 1-2 limbs; or mild decrease in touch, pain and/or moderate decrease in all proprioceptive tests in 3-4 limbs

4: Marked decrease in touch or pain or loss of proprioception, alone or combined, in 1-2 limbs; or moderate decrease in touch, pain and/or severe proprioceptive decrease in >2 limbs

5: Loss of sensation in 1-2 limbs; or moderate decrease in touch, pain and/or loss of proprioception for most of the body below the head

6: Sensation essentially lost below the head

0: Normal

1: Mild urinary hesitancy, urgency, or retention

2: Moderate hesitancy, urgency, retention of bowel or bladder, or rare urinary incontinence

3: Frequent urinary incontinence

4: In need of almost constant catheterization

5: Loss of bladder function

6: Loss of bowel and bladder function

0: Normal

1: Scotoma with visual acuity (corrected) better than 20/30

2: Worse eye with scotoma with maximal visual acuity (corrected) of 20/30 to 20/59

3: Worse eye with large scotoma, or moderate decrease in fields, but with maximal visual acuity (corrected) of 20/60 to 20/99

4: Worse eye with marked decrease of fields and maximal visual acuity (corrected) of 20/100-20/200; grade 3 plus maximal acuity of better eye of ≤20/60

5: Worse eye with maximal visual acuity (corrected) less than 20/200; grade 4 plus maximal acuity of better eye of 20/60 or less

6: Grade 5 plus maximal visual acuity of better eye of 20/60 or less

0: Normal

1: Mood alteration only (does not affect DSS score)

2: Mild decrease in mentation

3: Moderate decrease in mentation

4: Marked decrease in mentation (chronic brain syndrome, moderate)

5: Dementia or chronic brain syndrome, severe or incompetent

0: Normal

1: Any other neurologic findings attributed to MS

0: Fully ambulatory

4.0: Fully ambulatory, self-sufficient, up 12 hours a day despite relatively severe disability. Able to walk ≥500 meters without aid/rest

4.5: Fully ambulatory, able to work a full day, may require minimal assistance. Able to walk ≥300 meters without aid/rest

5.0: Ambulatory for 200 meters without aid/rest. Disability that impairs full daily activities (eg, to work full day without special provisions)

5.5: Ambulatory for 100 meters without aid/rest. Disability precludes full daily activities

6.0: Intermittent or unilateral constant assistance required to walk 100 meters, with/without resting

6.5: Constant bilateral assistance (canes, crutches, or braces) required to walk 20 meters without resting

7.0: Unable to walk >5 meters even with aid; (restricted to wheelchair); wheels self in standard wheelchair and transfers alone

7.5: Unable to take more than steps; restricted to wheelchair; may need aid in transfer; wheels self but cannot use standard wheelchair a full day; may require motorized wheelchair

8.0: Restricted to bed/chair or perambulated in wheelchair, but may be out of bed itself much of the day; retains many self-care functions; generally has effective use of arms

8.5: Restricted to bed much of the day; has some effective use of arms; retains some self-care functions

9.0: Helpless bed patient; can communicate and eat

9.5: Totally helpless bed patient; unable to communicate effectively or eat/swallow

10.0: Death due to MS