Low Dose Naltrexone & Disability
Click here for Survey results!


Take this survey after you have been on LDN at least 3 months. This survey is designed for users of LDN to track disability, using the Kurtzke Expanded Disability Status Scale (EDSS). We will compare EDSS at start of LDN, today, and every 3 months for 1 year. The rating can be from self assesment or your doctor.

Your contact information will ONLY be used by administrator for follow-up reminder, in 3 months.



1. * Date of Survey (mm/dd/yyyy)


2. * Your Name


3. * Your Email


4. * What is your gender?
Female
Male

5. * How many years ago were you diagnosed?


6. * What date did you start LDN, approximately? (mm/dd/yyyy)


7. * What mg dose are you taking?
Less than 2.0 mg
2.0 - 2.9 mg
3.0 - 4.4 mg
4.5 mg
More than 4.5 mg
Variable dose pattern

8. * Disease progression since starting LDN?
Too soon to tell
Better than before LDN
Progression has stopped
Progression has worsened

9. * How many relapses since starting LDN?
0
1
2
3
4 or more


Click Here to review the EDSS ratings.


10. * EDSS rating when you started LDN? (You can rate yourself)
0.0
1.0
1.5
2.0
2.5
3.0
3.5
4.0
4.5
5.0
5.5
6.0
6.5
7.0
7.5
8.0
8.5
9.0
9.5
Don't Remember

11. * EDSS rating today? (You can rate yourself)
0.0
1.0
1.5
2.0
2.5
3.0
3.5
4.0
4.5
5.0
5.5
6.0
6.5
7.0
7.5
8.0
8.5
9.0
9.5
Can't determine

12. * MS diagnosis when you started LDN?
Relapsing Remitting
Secondary Progressive
Progressive
Don't know

13. * MS diagnosis as of today?
Relapsing Remitting
Secondary Progressive
Progressive
Don't know

14. What country do you live in?



STOP! Please review to make sure you have answered all questions before clicking Submit.

Thanks for your participation!


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