Staging of MS

For the convenience of assessment of patient and administration of treatment we are staging the MS as:

  • According to Ayurvedic Constitution :

    • Grade 1 - Predominantly Kapha, Vata-Pitta-Kapha

    • Grade 2 - Kapha Pitta – Manageable groups

    • Grade 3 - Predominantly Pitta, Vata-Pitta – Difficult manage groups

    • Grade 4 - Predominantly Vata – Risk groups

Check your constitution


  • According to Symptoms of MS :



Grade 1

Grade 2

Grade 3

Grade 4






Localized area (Ex. In the limbs)

Aware only when you concentrate


Extremities or trunk not continuous.

Continuous, one joint to the other.(ex. Numbness below the knee)

Continuous, whole limb, half of body, face




Mild fatigue than during healthy days

Can walk and exercise but needs extra rest

3-4 hours active life

1-2 hours active life




Rarely instable(ex. while getting up from chair)

Mild but often, can stand on one foot

Unsteady, cannot stand on one foot

Unsteady, cannot stand independently



0-10% reduction in distance.

No visible gait change.

10-40% reduction in distance.

Mild change of gait.

40-70 % reduction in distance or

Visible changes in gait.


70-100% reduction in distance.

A few steps or not able to walk



Mild increased frequency, no urgency, no incontinence

Increased frequency -1 in 2 hours, increased urgency – can hold for 10 min, no incontinence

Increased frequency – 1 in less than 1 hour, increased urgency, less than 10 min, had or rarely incontinence

Incontinence often, using diapers



Constipated but daily

Constipated – 1 in 2 days

Had incontinence previously

Have incontinence. using diapers



Not influencing work in daily life but not efficient as earlier to MS

Affected but could lead normal life

Much affected, but needs help occasionally

Serious lack of memory, loss of continuity in words. Needs continuous help.



Calm and collected

Got or can get normal with mental support

Had pre MS-depressions

Had medication, continuous depression for 2 years





A bit anxious about MS, otherwise calm

Rarely getting anxious, fear, anger

Frequent getting anger, fear, anxiety

Constant fear, feeling of anxiety and anger

SPEECH & Swallowing











Mild, able to write or do other work in more than 1 year

Whole body tremor, unable to write, less than 1 year

  • According to lesions present :

    • Stage 1 – Recently occurred, few, smaller active or non-active cerebral lesion, more in periventricular region. Absence of spine lesions.

    • Stage 2 – Multiple lesions in the brain, and less than 2 lesions in the spine but not confluent, size of lesion not more than 3 mm.

    • Stage 3 – Moderately increasing multiple lesions in the brain and lesions in the spine that are confluent, size of the lesion 3mm – 6mm.

    • Stage 4 – Fast increasing lesion in brain and spine that are confluent, multiple lesions of size more than 6 mm, with brain volumn reduction and black holes. Lesions in the thalamus, pons, medulla and deep white matter.

  • According to type of MS :

    • Grade 1 – RRMS- cerebral form with less than 4 lesions.

    • Grade 2- PRMS

    • Grade 3- PPMS/SPMS

    • Grade 4 – NMO

  • Other Factors : Relapse

    • Grade 1 – First mild relapse and fast recovery

    • Grade 2 – 2-3 relapse, recovery easier

    • Grade 3 – 4 or more than 4 relapses but some symptoms persist.

    • Grade 4 – frequent relapse with incomplete recovery

  • EDSS

    • Grade 1 - EDSS 1.00-3.00

    • Grade 2 – EDSS 3.5 – 4.5

    • Grade 3 – EDSS 5.00- 6.5

    • Grade 4 – EDSS 7 and above

  • Mental status

    • Grade 1 – Content and happy nature without marked emotional disturbance.

    • Grade 2 – Moderate emotional disturbance related to MS.

    • Grade 3 – Frequent mental disturbance with mood swings, fear, and anxiety.

      •       With short duration intake of anti-depressives

      •       Mild changes in personality.

    • Grade 4 – Continuous depression and on frequent medications. 

      •    Noticeable changes in personality.

  • Accompanying disorders : the presence of other disorders complicates the healing process of MS

    • Grade 1 – apparently healthy, without any history of other diseases

    • Grade 2 – disease that are not related to neuro, psycho, immune, endocrine disorders.

    • Grade 3 – diseases related to neuro, psycho, immune, endocrine disorders.

    • Grade 4 – developmental childhood anomaly with other long standing or chronic disorders, or diseases under Grade 3.

  • Past medication especially immunosuppressive

    • Grade 1 – no major hospitalization or other MS medication

    • Grade 2 – short period of time on a few MS medication.

    • Grade 3 – moderate period of time on many MS medication.

    • Grade 4 – longer period of time after trying all MS medication available