Clinician reference tool — not medical advice. This is a clinical decision-aid intended for healthcare professionals: it gives deterministic suggestions to think with, not a diagnosis or a prescription. If you’re a patient, you’re welcome to look around — but please review anything here with your own doctor; it isn’t a substitute for personalized medical care.
Clinician / neurology reference tool — not a prescriber, not medical advice. Deterministic suggestions to think with, grounded in current MS guidelines and pivotal trials; the neurologist’s judgement, current product monographs, and live provincial coverage are always required. Runs entirely in your browser — no data is collected.

Evidence: Freedman MS, et al. (Canadian MS Working Group) 2020 · sources last checked 2026-07-22

Multiple sclerosis DMT selector

Pick the MS type, disease activity, and treatment strategy to get ranked disease-modifying therapy suggestions by efficacy tier — across the Health Canada-approved DMTs, with the guideline reasoning and references behind each. Modern framing: efficacy tier + MS type + activity, not “treatment lines”.

Guideline lens

Clinical profile

MS type

Disease activity

Strategy

Response to therapy

Cautions & contraindications

Pregnancy contraindicates teriflunomide; the other flags add strong cautions and deprioritize the affected agents rather than blanket-excluding them.

Safety & guideline notes

  • • Coverage: all agents shown are Health Canada-approved, but most DMTs require special-authority / Limited-Use provincial coverage — confirm against the live provincial formulary.

Select an MS type and disease activity to begin.

e.g. Relapsing-remitting + Highly active, or Primary-progressive to see how the phenotype gating shifts the menu.

Should I be tested?

Last reviewed 2026-09-23

Content for patients who ask to be tested for multiple sclerosis after tingling or numbness — separate from the disease-modifying-therapy selection above, which assumes an established diagnosis.

"Do I have MS?" after tingling or numbness

Defined testing criteria

Also called: Do I have MS?, MS testing, multiple sclerosis diagnosis, tingling MS worry, numbness MS

Tingling, numbness or brief visual symptoms are common, and searching them online quickly surfaces multiple sclerosis. Health anxiety, a family history, or something read about MS on social media often brings someone in specifically asking to be tested for it. The concern is reasonable: MS is a real, definable diagnosis with defined criteria. But most tingling and numbness is not MS, and it's worth being specific about what does and doesn't point that way.

Raises suspicion

  • • Loss or reduction of vision in one eye with painful eye movements (optic neuritis), or double vision
  • • Ascending sensory disturbance and/or weakness, or altered sensation/pain travelling down the back and into the limbs on bending the neck forward (Lhermitte sign)
  • • New bladder difficulty alongside a sensory change, or progressive difficulty with balance and gait
  • • Symptoms lasting more than about 24 hours, or a pattern that is new, clearly worse, or unexplained by an obvious cause

Does not raise suspicion

  • • Brief tingling that comes and goes over seconds to minutes
  • • Tingling clearly tied to position (leaning on an arm, crossing legs) or worse with anxiety or hyperventilation
  • • Numbness in a single nerve distribution consistent with nerve compression, such as carpal tunnel syndrome
  • • An isolated symptom with no other neurological findings on exam

Red flags

  • • Sudden vision loss, new weakness, or new bladder/bowel retention or incontinence: need urgent assessment
  • • Rapidly progressive symptoms over hours: need urgent assessment

Who to test

  • A symptom pattern suggestive of MS (see raises_suspicion), after common alternative causes are consideredMRI of the brain and spinal cord, applying the 2017/2024 McDonald criteria, done by or with neurology; CSF oligoclonal bands may support the diagnosis. No TestSelect entry: this is an imaging- and specialist-led diagnosis, not a lab panel.
  • Tingling or numbness where a common, treatable mimic is plausible: Vitamin B12 (cobalamin) (Situation-specific), HbA1c and fasting glucose (diabetes screening) (Situation-specific)B12 deficiency and diabetic neuropathy are common, treatable causes of numbness or tingling worth checking before or alongside a neurology referral.

More likely instead

  • • benign paresthesia from anxiety or hyperventilation
  • • positional or compressive nerve symptoms (e.g. sleeping on an arm)
  • • carpal tunnel syndrome or another focal nerve entrapment
  • • B12 deficiency
  • • diabetic peripheral neuropathy

Counselling script

“If you're having brief, come-and-go tingling with nothing else going on, that's not typically how MS presents, and no blood test exists to check for MS anyway. If you have features like vision loss with eye pain, numbness spreading over hours, or new bladder symptoms, an MRI and a neurology referral are the right next step. Either way, we can check for simpler, treatable causes like B12 deficiency first.”

Chart snippet (OSCAR-safe plain text)

Concern discussed, not tested

Concern re: multiple sclerosis discussed, raised by patient after tingling/numbness or online research.
Discriminating features: optic neuritis, double vision, ascending sensory change, Lhermitte sign, bladder involvement, symptoms over 24 hours; reviewed.
Red flags: acute vision loss, new weakness, bladder or bowel retention; absent.
Assessment: symptom pattern reviewed against MS-suggestive discriminating features; pattern not consistent with MS red flags today.
Plan: reassurance given; B12 and A1C/glucose considered for common treatable mimics.
Ref: NICE NG220 2022; McDonald criteria 2017 (Thompson et al, Lancet Neurology 2018).
Patient given info page: https://ms.ajaxharwoodclinic.com/patient
Revisit if: new or spreading neurological symptoms, vision changes, or bladder symptoms develop.

Testing ordered

Concern re: multiple sclerosis discussed.
Discriminating features: optic neuritis, double vision, ascending sensory change, Lhermitte sign, bladder involvement, symptoms over 24 hours; reviewed.
Assessment: pattern warrants further work-up for a treatable mimic and/or neurology referral.
Plan: B12 and A1C/glucose ordered; MRI and neurology referral arranged if features suggestive of MS persist.
Ref: NICE NG220 2022; McDonald criteria 2017 (Thompson et al, Lancet Neurology 2018).
Patient given info page: https://ms.ajaxharwoodclinic.com/patient
Revisit if: new or spreading neurological symptoms develop, or results do not explain the picture.

Revisit if

  • • New or worsening neurological symptoms develop
  • • Symptoms persist or progress despite a reassuring initial assessment
  • • B12 or glucose results do not explain the symptom pattern

References

  1. 1. NICE. Multiple sclerosis in adults: management (NG220) (2022)Refer people suspected of having MS for diagnosis by a consultant neurologist or specialist
  2. 2. NICE. Multiple sclerosis in adults: management (NG220) (2022)Lists the common presenting features of MS: monocular painful visual loss, double vision, ascending sensory disturbance/weakness
  3. 3. International Panel on Diagnosis of Multiple Sclerosis. Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria (2018)Defines the McDonald criteria requirements for dissemination in time and space of CNS lesions on MRI, used to diagnose MS
Evidence notes

Tag rationale: A, borderline and worth flagging to Dr. Yu. MS has defined diagnostic criteria (McDonald 2017, revised 2024) requiring MRI, clinical findings and sometimes CSF, which fits the schema's definition of A ('defined testing criteria'). It is unusual among A-tagged records in this batch because 'who_to_test' has no lab test id at all (the diagnostic tool is imaging plus specialist exam, not a blood draw); a reasonable physician could instead call this B, since no single test settles it the way serology does for celiac. Tagged A here because the criteria, though not lab-based, are precisely defined and non-clinical (an MRI protocol with explicit rules), unlike a genuinely clinical-judgement diagnosis such as fibromyalgia or ME/CFS. This record adds diagnostic-workup content that ahc-ms currently lacks (the app is a disease-modifying-therapy selector with no diagnostic section, per docs/ecosystem-survey.md) and does not duplicate its existing DMT-monitoring references. NG220's referral/diagnosis recommendations are dated [2022, amended 2026] on the live page, so treated as current.

References

  1. [1]Rae-Grant A, et al. Practice guideline recommendations summary: Disease-modifying therapies for adults with multiple sclerosis (AAN 2018). Neurology 2018;90:777. link
  2. [2]Montalban X, et al. ECTRIMS/EAN guideline on the pharmacological treatment of people with multiple sclerosis. Mult Scler J 2018;24(2):96 (with subsequent updates). link
  3. [3]Freedman MS, Devonshire V, Duquette P, et al. Treatment Optimization in Multiple Sclerosis: Canadian MS Working Group Recommendations. Can J Neurol Sci 2020;47(4) (early effective treatment, monitoring, switching and sequencing of disease-modifying therapies). link
  4. [4]Health Canada — Drug Product Database & product monographs (interferon beta, glatiramer acetate, teriflunomide, fumarates, S1P modulators, cladribine, ocrelizumab, ofatumumab, ublituximab, natalizumab, alemtuzumab). link
  5. [5]Montalban X, et al. ORATORIO: Ocrelizumab versus placebo in primary progressive multiple sclerosis. NEJM 2017;376:209. link
  6. [6]Kappos L, et al. EXPAND: Siponimod versus placebo in secondary progressive multiple sclerosis. Lancet 2018;391:1263. link
  7. [7]Ho P-R, et al. Natalizumab and PML risk stratification by anti-JC virus antibody index, prior immunosuppressant use, and treatment duration. Lancet Neurol 2017;16:925. link
  8. [8]Product-monograph safety programmes for anti-CD20 monoclonals (ocrelizumab, ofatumumab, ublituximab): hepatitis B screening and reactivation management before initiation. link