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Division of Neurology (Drs. Willoughby and Paty), Department of Medicine, University of British Columbia, Vancouver, BC, Canada, and the Department of Neurology (Dr. Willoughby), University of Auckland, Auckland, New Zealand.
We reviewed scales proposed over the past 35 years for the rating of neurologic impairment in MS. We focused on the Expanded Disability Status Scale (EDSS) which has been recommended as the most useful scale for rating impairment by the International Federation of Multiple Sclerosis Societies in its Minimal Record of Disability for Multiple Sclerosis. We consider that the EDSS has important flaws that seriously limit its usefulness. In light of the widely accepted three-tier classification of dysfunction developed by the World Health Organization, the title is inappropriate. More substantial problems include inadequate precision in defining the degree of impairment in some functional categories of the scale, and the use of a mixture of neurologic signs elicited on examination and subjective information obtained from the patient in defining the overall scale. We suggest guidelines for developing a "Neurologic Impairment Scale" to rate impairment in MS.
Address correspondence to Dr. Paty, Department of Medicine, Division of Neurology, University of British Columbia, Vancouver, BC V5Z 3J5, Canada. Address reprint requests to Dr. Willoughby, Department of Neurology, University of Auckland, Auckland, New Zealand.
The studies that support this article were supported by the MS Society of Canada, the Kroc Foundation, and the Jacob W. Cohen Fund for Research in Multiple Sclerosis.
Received April 15, 1988. Accepted for publication in final form May 12, 1988.
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