Multiple Sclerosis (MS) Severity Scale
- Thursday, July 23, 2009, 13:37
- Multiple Sclerosis
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- Lynn:
- For those of us with MS, what can your panel tell us about the factors that can determine the severity of MS?
- Dr. Lynch:
- That’s one of the big questions that we always want to know when somebody comes in. Is this person going to have bad MS, are they going to have medium MS, or is it going to be mild? And the basic answer is in a specific given person – we cannot tell. Sometimes, there are indicators that give us a good feeling or a bad feeling for whether somebody’s going to do badly or well. A person with a lot of lesions on their MRI scan we tend to worry a lot about. A person who from the beginning has frequent relapses very close together, that’s considered to be a bad sign. Someone’s whose first attack is balance and coordination difficulty, that tends to be a bad sign. If they’re progressive from the beginning, it’s a bad sign. And of course, if they’re doing badly in five years, it’s a bad sign.
- Michelle Keating:
- I’d also just make one additional comment. Even though there are all those prognostic factors that are looked at, in general when you look at statistics, and we can see these general pictures, remember that in any one individual how you’re going to do over a period of time, no one can predict that. I look back on my first two years of diagnosis when I had very frequent relapses. I had some motor involvement at the very beginning, and based on that initial information, probably most physicians would have said, “You have some negative signs.” But here I am living with the disease now for 21 years, and doing very well. And so I would say all the prognostic information is not necessarily going to be predictive in any one individual. And, there’s more to dealing with this disease than just the physical aspects of the disease. It’s also part of the mental picture, as we’ve all talked about tonight.
- Rick:
- So, in terms of sort of rating MS, I know there are the categories. Is there a severity scale? I know sometimes people are diagnosed that way with pain, for example. Is there a rating scale for MS like that?
- Dr. Lynch:
- Yes. We generally rate people according to the Extended Disability Status Scale. We call it the EDSS. And basically, it’s just a scale that’s used to say how many things does this person have that I can objectively show are wrong with them, and how bad are each one of those things? And that gives us a global score.
- Rick:
- Right.
- Dr. Lynch:
- In general, a person with a 0 is doing well, a person with a 10 is dead, and that means I’ve never seen anybody that came into my office with a 10. A person who requires a cane to walk and cannot walk without it is a 6. A person who requires a walker or can go no more than 60 feet is a 6.5. And so the scale goes so that we can say, “Well, you’re an X on this scale,” and that will give you some general idea, but that scale is not completely ordinal. And so it makes it hard to know the change from a 3 to a 4 is not the same as the change from a 6 to a 7. That’s what I mean by ordinal, by the way.
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