Symptoms of multiple sclerosis can vary both in their occurrence, frequency and severity. The EDSS scale is often used to assess the impairment. This article explains what the EDSS score is and what is behind benign and malignant MS.

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What is the EDSS scale?

EDSS stands for Expanded Disability Status Scale. It provides information on the degree of disability in people with multiple sclerosis and is used by therapists to evaluate and document the course of multiple sclerosis. The scale ranges from zero to ten. The scale does not rate linearly, i.e. a value of 6.0 is not twice as bad as 3.0. Instead, the degree of disability increases exponentially within the scale levels, meaning that there are ever greater restrictions from level to level. The EDSS scale is based on studies of various functional systems in humans. These are that

• pyramidal tract function system (influences paralysis, for example)
• cerebellum function system (influences e.g. disorders of movement coordination (ataxia), involuntary, rhythmic trembling (tremor))
• brainstem function system (influences speech and/or swallowing disorders, for example)
• Sensory function system (influences, for example, reduction of the sense of touch)
• bladder and/or rectum function system (influences incontinence, for example)
• visual function system (influences e.g. limited field of vision)
• cerebral function system (influences e.g. memory difficulties, change of character)

However, the EDSS scale is only one tool for determining the impairment of multiple sclerosis. Influencing factors such as fine motor skills, concentration disorders or fatigue are only slightly taken into account and are therefore assessed separately.

BEnigne MS

Benign MS is a benign course of the disease. It is defined as a form of progression in which, after more than 15 years after the onset of the disease, an EDSS value of three or less is present. Grade 3 on the EDSS scale is awarded when

• Grade 2 (mild disability) of the impairment is identified in three to four functional systems, or
• in a functional system grade 3 moderate degree of disability) of the impairment is detected and
• all other functional systems are rated zero or one.

It is impossible to predict whether a patient will have a benign course. However, Swedish scientists were able to show in a data set with 11,222 MS patients that 21% of this patient group had a benign course. Women had a benign course more often than men (75.5% vs 70.1%). Multiple sclerosis was also diagnosed at a younger age than in patients with a non-benign course (28.3 vs. 32.9 years).
The researchers also found that as the duration of the illness increased, the probability of a further benign course fell: After 20 years, the probability of a further benign course was 53%, after 25 years 28%, after 30 years 15%.

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MAligned MS

Malignant MS, also known as the marbug variant of multiple sclerosis, affects around 2% of MS patients. In contrast to benign MS, malignant MS describes a particularly aggressive, malignant course.

Malignant MS is a very rare form of multiple sclerosis, which describes a rapid or more brilliant course of MS. Young people in particular are affected by this. The most common initial symptoms include fever, headache, vomiting, confusion and neurological problems. With this very rare MS, those affected can die within a few weeks.

In our YouTube video, Mathias explains to you in more detail the various forms of MS.

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