A New Scale for Evaluating Disability in Multiple Sclerosis

IT HAS LONG BEEN APPARENT that an objective and reproducible method of evaluating patients with multiple sclerosis was necessary. Next to the unpredictable course for the individual with this disease, the absence of such a means of measuring disability has been a prime factor in the known difficulty of evaluating proposed therapies in multiple sclerosis. Prior attempts at mensuration range from the all-or-none categorization of MacLean and Berkson' (incapacitated or not incapacitated) to the complex schema of Alexander,* but there is no generally accepted scale in present use. The goal of a rating-scale is threefold: 1) that the sum-total of any patient's disabilities should fit him into a suitable category; 2) that any change in disability should be reflected in a corresponding change of status; and 3) that the scale be simple enough to be manageable. The scale to be presented was devised to evaluate a possible therapeutic agent for multiple ~clerosis.~ In the course of that work over 300 cases of multiple sclerosis were studied; all were assignable in this scale. It was used to measure status on admission to and discharge from the hospital in order to establish a baseline with which to compare the in-hospital course of groups of patients.