From the Guidelines
The EDSS step for this patient is 3.0, reflecting moderate disability with a relatively preserved walking range. The patient's visual acuity of 20/400 (0.05) in the left eye falls into category 3 of visual impairment, as defined by the vision rehabilitation preferred practice pattern 1. This category indicates significant visual impairment, which contributes to the overall disability assessment. Additionally, the complete left internuclear ophthalmoplegia and mild muscle weakness (BMRC grade 4) in one muscle group indicate neurological deficits in multiple functional systems. However, the patient's unrestricted walking range is a critical factor in determining the EDSS score, as it suggests that despite these deficits, the patient remains ambulatory without significant limitation.
- Key factors influencing the EDSS score include:
- Visual impairment: The patient's visual acuity places them in category 3, indicating significant visual loss 1.
- Brainstem involvement: The complete left internuclear ophthalmoplegia suggests brainstem dysfunction.
- Muscle weakness: A BMRC grade of 4 indicates mild weakness but preserved muscle function.
- Cerebral involvement: Mild memory impairment suggests some level of cognitive dysfunction.
- Ambulation: The patient's walking range is unrestricted, which is a key factor in the EDSS scoring system. Given these considerations and based on the most recent and highest quality evidence available 1, the EDSS step of 3.0 reflects the patient's moderate level of disability while acknowledging the preservation of ambulatory function.
From the Research
Determining EDSS Step
To determine the EDSS (Expanded Disability Status Scale) step for a patient with specific neurological impairments, we need to consider the provided clinical details:
- Visual acuity of 20/400 (0.05) in the left eye
- Complete left internuclear ophthalmoplegia
- A BMRC (British Medical Research Council) grade of 4 in one muscle group, indicating significant muscle weakness
- Mild memory impairment
- Unrestricted walking range
Clinical Impairments and EDSS
The EDSS is a method of quantifying disability in multiple sclerosis patients [ 2 ]. It assesses several functional systems, including visual, pyramidal, cerebellar, brainstem, sensory, bowel and bladder, cerebral, and others. The scale ranges from 0 (normal neurological examination) to 10 (death due to multiple sclerosis), with increments of 0.5 or 1.0 [ 2 ].
Assessing the Patient's Condition
Given the patient's visual acuity of 20/400 in one eye, this would likely affect the visual functional system score. Complete left internuclear ophthalmoplegia would also impact the brainstem functional system. A BMRC grade of 4 in one muscle group suggests significant weakness, affecting the pyramidal functional system. Mild memory impairment could influence the cerebral functional system score. However, the unrestricted walking range suggests that, despite these impairments, the patient's ambulation is not significantly compromised.
EDSS Step Determination
The exact EDSS step cannot be directly calculated from the provided information without a detailed assessment of all functional systems and the application of the EDSS scoring criteria. However, considering the impairments mentioned, the patient would likely have an EDSS score reflecting moderate disability, given the presence of significant visual and motor impairments but preserved ambulation [ 3 ].
Considerations
- The variability in gait measures across EDSS categories, as shown in [ 4 ], highlights the complexity of assessing disability in multiple sclerosis patients and the potential for significant variability within the same EDSS step.
- The impact of relapses and disease progression on EDSS scores, as discussed in [ 3 ] and [ 5 ], further complicates the determination of the EDSS step and emphasizes the need for regular assessments.
Conclusion Not Provided as per Request
Details on calculating the exact EDSS step based on the provided clinical information are not directly available from the given studies. The EDSS step would depend on a comprehensive neurological examination assessing all functional systems [ 2 ].