Pyramidal functions Normal pyramidal function Abnormal pyramidal signs without disability Minimal pyramidal disability Mild or moderate paraparesis or hemiparesis, or severe monoparesis Marked paraparesis or hemiparesis, moderate quadriparesis, or monoplegia Paraplegia, hemiplegia, or marked quadriparesis Quadriplegia
Kurtzke grade for this functional system. While the person walks some 500 meters without aid, these grades set the step from 0 through 4. Above 4 the functional-system patterns in the paper are usual, not required. Cerebellar testing that cannot be done because of weakness is not given a substitute grade. Temporal pallor beside the visual grade does not change the number.
Cerebellar functions Normal cerebellar function Abnormal cerebellar signs without disability Mild ataxia Moderate truncal or limb ataxia Severe ataxia in all limbs Unable to perform coordinated movements because of ataxia
Kurtzke grade for this functional system. While the person walks some 500 meters without aid, these grades set the step from 0 through 4. Above 4 the functional-system patterns in the paper are usual, not required. Cerebellar testing that cannot be done because of weakness is not given a substitute grade. Temporal pallor beside the visual grade does not change the number.
Brainstem functions Normal brainstem function Brainstem signs only Moderate nystagmus or other mild brainstem disability Severe nystagmus, marked extraocular weakness, or moderate disability of other cranial nerves Marked dysarthria or other marked brainstem disability Unable to swallow or speak
Kurtzke grade for this functional system. While the person walks some 500 meters without aid, these grades set the step from 0 through 4. Above 4 the functional-system patterns in the paper are usual, not required. Cerebellar testing that cannot be done because of weakness is not given a substitute grade. Temporal pallor beside the visual grade does not change the number.
Sensory functions Normal sensation Decreased vibration or figure-writing in one or two limbs only Mild loss of touch, pain, or position in one or two limbs, or vibration loss alone in three or four limbs Moderate loss of touch, pain, or position, or vibration essentially lost, in one or two limbs; or mild touch or pain loss with moderate proprioceptive loss in three or four limbs Marked loss of touch or pain, or loss of proprioception, in one or two limbs; or moderate touch or pain loss with severe proprioceptive loss in more than two limbs Sensation essentially lost in one or two limbs, or moderate touch or pain loss with proprioception lost for most of the body below the head Sensation essentially lost below the head
Kurtzke grade for this functional system. While the person walks some 500 meters without aid, these grades set the step from 0 through 4. Above 4 the functional-system patterns in the paper are usual, not required. Cerebellar testing that cannot be done because of weakness is not given a substitute grade. Temporal pallor beside the visual grade does not change the number.
Bowel and bladder functions Normal bowel and bladder Mild urinary hesitancy, urgency, or retention Moderate hesitancy, urgency, or retention, or rare urinary incontinence Frequent urinary incontinence Almost constant catheterization Loss of bladder function Loss of bowel and bladder function
Kurtzke grade for this functional system. While the person walks some 500 meters without aid, these grades set the step from 0 through 4. Above 4 the functional-system patterns in the paper are usual, not required. Cerebellar testing that cannot be done because of weakness is not given a substitute grade. Temporal pallor beside the visual grade does not change the number.
Visual functions Normal vision Scotoma with corrected acuity better than 20/30 Worse eye with a scotoma and corrected acuity from 20/30 to 20/59 Worse eye with a large scotoma or moderate field loss, and corrected acuity from 20/60 to 20/99 Worse eye with marked field loss and corrected acuity from 20/100 to 20/200, or the grade-3 pattern plus better-eye acuity of 20/60 or worse Worse eye with corrected acuity worse than 20/200, or the grade-4 pattern plus better-eye acuity of 20/60 or worse Grade 5 plus better-eye corrected acuity of 20/60 or worse
Kurtzke grade for this functional system. While the person walks some 500 meters without aid, these grades set the step from 0 through 4. Above 4 the functional-system patterns in the paper are usual, not required. Cerebellar testing that cannot be done because of weakness is not given a substitute grade. Temporal pallor beside the visual grade does not change the number.
Cerebral functions Normal cerebral function Mood alteration only Mild decrease in mentation Moderate decrease in mentation Marked decrease in mentation Dementia or severe chronic brain syndrome
Cerebral grade 1 is mood alteration only and does not change the step. Grade 2 and higher do count.
Other neurologic findings No other finding attributed to multiple sclerosis Another finding attributed to multiple sclerosis
Kurtzke grade for this functional system. While the person walks some 500 meters without aid, these grades set the step from 0 through 4. Above 4 the functional-system patterns in the paper are usual, not required. Cerebellar testing that cannot be done because of weakness is not given a substitute grade. Temporal pallor beside the visual grade does not change the number.
Walking and daily activity Walks some 500 meters without aid Walks some 300 meters without aid Walks about 200 meters without aid Walks about 100 meters without aid Unilateral aid to walk about 100 meters Constant bilateral aid to walk about 20 meters Unable to walk beyond about 5 meters; wheels self and transfers alone No more than a few steps; may need help to transfer Restricted to bed or chair, up much of the day, with effective arm use In bed much of the day, with some effective arm use Helpless in bed, but can communicate and eat Completely helpless and unable to communicate effectively or swallow Death due to multiple sclerosis
If the person can walk some 500 meters without aid, the step comes from the functional systems and stops at 4. A shorter walk, an aid, a chair, or bed sets the step from that description. Death due to multiple sclerosis is step 10.