Report Viewer

NINDS CDE Notice of Copyright
Burke-Fahn-Marsden Movement Scale (BFMMS)
Please visit this website for more information about the instrument: Burke-Fahn-Marsden Movement Scale
Supplemental: Mitochondrial Disease (Mito)
Short Description of Instrument
The Burke-Fahn-Marsden Movement Scale (BFMMS) is a validated subscale of the Burke-Fahn-Marsden Dystonia Rating Scale. (Kuiper et al., 2016). The BFMMS measures dystonia in nine body regions, eyes, mouth and speech, swallowing, neck, trunk, arms, and legs. (Burke et al., 1985; Kuiper et al., 2016)
Scoring and Psychometric Properties
Scoring: The BFMMS score is the sum of individual scores for each of the nine body regions with scores ranging from 0 (minimum) to 120 (maximum). (Kuiper et al., 2016) The individual score for each region is the product of two factors, the Provoking Factor and the Severity Factor. Each factor is rated from 0 (lowest) to 4 (highest). (Burke et al., 1985) The Provoking Factor quantifies the dystonia in a given region by rating the circumstances in which the dystonia appears, while the Severity Factor quantifies the severity of dystonia in a region regardless of the circumstances in which it appears. (Burke et al., 1985) The scores for eyes, mouth and speech, and neck are each multiplied by 0.5 before entering in the calculation of the total score to 'downweight' them.
Psychometric Properties: The concordance between three unblinded clinical raters and one single-blinded rater for 10 prospective series of ratings on the BFMMS was evaluated in 22 dystonic patients. Ten assessments on the BFMMS were performed under various stimulation conditions at different time points (before surgery and 1, 3, 6, and 12 months afterwards). Patients were first evaluated by three unblinded clinical raters (one per center). The intra-rater reliability at inclusion was better for the blinded rater than for the clinical raters. The inter-rater reliability (comparing the blinded rater with each clinical rater) was "very good" at inclusion, "fair" at month 1 and was "good" at month 3, month 6, and month 12. As inter-rater reliability is good in trained unblinded raters, the BFMMS may also be used in the follow up of dystonic patients in movement disorders centers, in clinical practice (Krystkowiak et al., 2007).
Strengths: Includes a patient relevant disability scale; not burdening to patients. Scale is reliable for following a patient's course and response to treatment.
Weaknesses: Time consuming to assess with two examiners; complicated weighting system; too detailed dystonia severity scale; not responsive to treatment whilst other functional factors did improve; designed for adults.
Key Reference:
Burke RE, Fahn S, Marsden CD, Bressman SB, Moskowitz C, Friedman J. Validity and reliability of a rating scale for the primary torsion dystonias. Neurology. 1985 Jan;35(1):73-7.
Additional References:
Albanese A, Sorbo FD, Comella C, Jinnah HA, Mink JW, Post B, Vidailhet M, Volkmann J, Warner TT, Leentjens AF, Martinez-Martin P, Stebbins GT, Goetz CG, Schrag A. Dystonia rating scales: critique and recommendations. Mov Disord. 2013 Jun 15;28(7):874-83.
Gimeno H, Tustin K, Selway R, Lin JP. Beyond the Burke-Fahn-Marsden Dystonia Rating Scale: deep brain stimulation in childhood secondary dystonia. Eur J Paediatr Neurol. 2012 Sep;16(5):501-8.
Krystkowiak P, du Montcel ST, Vercueil L, Houeto JL, Lagrange C, Cornu P, Blond S, Benabid AL, Pollak P, Vidailhet M; SPIDY Group. Reliability of the Burke-Fahn-Marsden scale in a multicenter trial for dystonia. Mov Disord. 2007 Apr 15;22(5):685-9.
Kuiper MJ, Vrijenhoek L, Brandsma R, Lunsing RJ, Burger H, Eggink H, Peall KJ, Contarino MF, Speelman JD, Tijssen MAJ, Sival DA. The Burke-Fahn-Marsden Dystonia Rating Scale is Age-Dependent in Healthy Children. Mov Disord Clin Pract. 2016 May 3;3(6):580-86.
Marsden CD, Schachter M. Assessment of extrapyramidal disorders. Br J Clin Pharmacol. 1981 Feb;11(2):129-51.
Monbaliu E, Ortibus E, Roelens F, Desloovere K, Deklerck J, Prinzie P, de Cock P, Feys H. Rating scales for dystonia in cerebral palsy: reliability and validity. Dev Med Child Neurol. 2010 Jun;52(6):570-5.
Pavone L, Burton J, Gaebler-Spira D. Dystonia in childhood: clinical and objective measures and functional implications. J Child Neurol. 2013 Mar;28(3):340-50.
Document last updated March 2024