Multiple Sclerosis Explained: Symptoms, Diagnosis & Treatment

Multiple sclerosis (MS) is often called “the disease of a hundred faces” because it can look different for every patient. In this episode of Baptist Health Talk, neurologist Dr. Luis Compres-Brugal breaks down the early warning signs of MS, how it’s diagnosed, and what modern treatments mean for patients today.

From fatigue and brain fog to vision changes and mobility challenges, we explore the symptoms people most commonly search for—and the ones that often go unnoticed. You’ll also learn what causes MS, how it’s frequently misdiagnosed, and why early, aggressive treatment can make a major difference.

If you or someone you love is experiencing neurological symptoms, this episode offers clear, expert-backed guidance to help you understand what’s happening and what to do next.

🔔 Subscribe for more trusted health insights from Baptist Health experts.

Host:
Sandra Peebles
Award-Winning Journalist

Guest:
Luis Compres-Brugal, M.D.
Neurologist 
Baptist Health Miami Neuroscience Institute

If you found this episode helpful, you may also enjoy:

Understanding Multiple Sclerosis: The Battle Within

Transcript

SPEAKER_00 0:00

Multiple sclerosis can manifest in so many different ways. We call it the disease of a hundred faces. So I have not seen a patient that looks like the other.

SPEAKER_01 0:11

Welcome to Baptist Health Talk, a podcast on all things healthcare, powered by Baptist Health South Florida, your trusted source for healthcare prevention and wellness.

SPEAKER_02 0:21

Hello everyone, I'm your host, Andrew Peebles. Welcome back to a new episode of Baptist Health Talk, where we answer your most searched questions on trending health topics. Today, we're diving into multiple sclerosis, often called MS, a complex neurological condition that affects how the brain and the body communicate. From early warning signs to the latest treatment options and the truth behind common misconceptions, we're giving you the clear, real-world answers people everywhere are searching for. We are joined by Dr. Luis Compres Brugal, neurologist at Baptist Health Miami Neuroscience Institute. And thank you so much for being here.

SPEAKER_00 1:00

Thank you very much for having me.

SPEAKER_02 1:02

Well, let's get to the basics. When people search the internet and they look uh for up MS, they often ask, what are the early signs? So, in your opinion, a medical opinion, what are the first warning signs, those red flags that let you know, yes, it's multiple sclerosis?

SPEAKER_00 1:18

Yeah, it's uh a little bit challenging because multiple sclerosis can manifest in so many different ways. We call it the disease of a hundred faces. So I have not seen a patient that looks like the other. Um, it can be fatigue, numbness, or weakness in one side of the body, can be just coming and going for years. However, we do have uh what we call MS attacks, which are clear changes, uh neurological changes that uh once they come in, they can last for hours or days, and um are new symptoms that you didn't have before. For example, one of the most common ones is uh vision loss. Um may have some blurry vision in one eye, or uh pain when moving the eye, or weakness or numbness in one side of the body. Uh it varies a lot.

SPEAKER_02 2:15

You mentioned that it varies from person to person. What would be one of those symptoms that really worries people most? What's one of those that really changes your life?

SPEAKER_00 2:24

Yes, so that is gonna vary per patient. Um, one of the most common and disabling ones are the invisible symptoms. So those symptoms that no one else can say but the patient can feel. And they tend to be fatigue, brain fog, or depression. Those are um, I would say a majority of patients may have some fatigue to a certain degree. And it's not just the uh tiredness that you feel at the end of the uh workday. It's more draining, more physically draining fatigue. Um, and even some patients can go on disability because of this.

SPEAKER_02 3:05

But that's really challenging because so many of us are tired with this you know fast-paced world that we live in and with so many responsibilities. So, how do we differentiate that regular fatigue from a fatigue that could be uh life-altering, like uh an MS diagnosis?

SPEAKER_00 3:19

Yeah, awesome question. And uh yes, fatigue is so common in all of us. What we do when we see a patient is try to make sure what else could be going on. We cannot just say, oh, this patient is having fatigue. It's because of MS. Of course not. We have to rule out sleep, uh, sleep problems, anemia, even thyroid issues can cause fatigue. Um, so fatigue by itself is not necessary for uh diagnosis. Um patients with MS are gonna have other symptoms as well.

SPEAKER_02 3:52

How do you how do you diagnose MS?

SPEAKER_00 3:55

There's no single test. We don't have a blood test that we can uh just get blood and get a diagnosis. No. It's like building a puzzle. We have to put in what the patient is telling us, the exam that we are doing, the MRI, sometimes we need lumbar puncture and some other advanced imaging techniques. And once we get all that, we can put everything together and we can say, okay, this actually looks like MS. And that's how we come to a diagnosis. It's really challenging to diagnose it. I would say, or that somebody says approximately one out of five or six patients with a diagnosis of MS, they don't actually have MS. Interesting. So there's a lot of misdiagnosis. Uh, the new criteria that came out last year, and we are all all excited about the goal is to reduce how the um the misdiagnosis of MS. And it's really exciting and something that I'm passionate about in determining the right diagnosis for these patients. And um yeah, it's uh complex, but uh I enjoy the process and and and walking the patient through that process.

SPEAKER_02 5:02

Fascinating as a scientist, doctor, but certainly challenging if you're the one with the with the diagnosis. So one of the questions that is most searched is what actually causes MS? Is there a cause or is this still an unknown?

SPEAKER_00 5:17

We do know that certain uh parameters need to be met for a diagnosis of MS. There is no one single cause. There is a genetic predisposition, but we have triggers. And those triggers can be um an infection with Epsom bar virus, low vitamin D, living uh away from the equator is a risk factor. Um, and there are many other ones. I explain it as a domino effect. You need to have uh one for the other one to get triggered. You a single one of those won't give you MS. We don't have an exact cause yet.

SPEAKER_02 5:54

So if a person is watching and thinking maybe they have some of these symptoms, what would be the trigger for them to pick up the phone and go see a doctor?

SPEAKER_00 6:04

If they're having any neurological symptom that they didn't have uh before, or if there's something that is really bothering them, I would say get evaluated. Why? Um let us figure out if this is actually something to be worried about, maybe nothing, but let us do that job. Ethernet is great, there's a lot of information there, but um it can either underestimate the symptoms or create unnecessary anxiety. So just go to the neurologist, talk about it, and we'll do the assessment.

SPEAKER_02 6:38

Doctor, MS symptoms really overlap with a lot of other conditions. So, what is it most commonly mistaken for? And what can doctors do to really know what's going on?

SPEAKER_00 6:51

That is uh a great question and very challenging because we don't have a single test to diagnose MS. Uh, one of the most common conditions um patients get mistakenly diagnosed with MS is migraines. Migraines or even high blood pressure. Sometimes that can cause spots in the brain that can look similar to the ones in MS, um, and they can get a diagnosis of MS from that standpoint. Um, we can fall in the pitfall of uh uh adding MRI lesions and some neurological symptoms, therefore MS, which in reality that's not the way.

SPEAKER_02 7:24

I mean, you mentioned MRI. Is that an MRI of the brain, of the spinal cord? What are you looking at? And what are you looking for?

SPEAKER_00 7:31

All the above. The brain is uh the main one. What I'm looking for is specific lesions, specific spots in it uh with a specific shape. MS lesions um they like to go through certain areas of the brain and the spinal cord. Um, and once we see that, we can have a suspicion, okay, this is MS. Nowadays, um, and with the new criteria, we have more advanced MRI um technology that we can look at different metrics and see if that lesion is actually from MS or not, which is really exciting.

SPEAKER_02 8:05

And when we see a patient that is diagnosed, their symptoms begin to progress, what can be done to manage those symptoms?

SPEAKER_00 8:15

That is one of the biggest uh or the biggest unmet needs in MS, targeting the progression. We have done a great job at stopping relapses, meaning stopping new lesions from forming in the brain. Um, but that progression that occurs over time, we haven't been there yet. We are getting there. Um we have to focus on symptomatic management, a lot of physical therapy, treating comorbidities, if there's uh anxiety, depression, or pain, making sure we are treating those because they can either exacerbate the progression or give the impression that the patient is getting worse. When in reality, maybe their symptoms are not well controlled.

SPEAKER_02 8:56

When we see medicine today, everything has changed so much. I mean, from the surgeries that we talk about here on this podcast, uh recovery is so much better. Really, the the experience for the patient has improved so much through the years. I know it has improved also for uh MS patients, but what are some of the newer therapies that are helping people live a longer life, live a better quality life?

SPEAKER_00 9:17

Well, we have learned is that we need to tackle MS as aggressive as possible and as early as possible. So now we have uh what we call high efficacy therapy, many different ones. We have through the veins, oral pills, and injections that they can they're doing a great job at stopping new relapses. And that is something that we didn't have even 10 years ago. Um, patients um diagnosed with MS 20, 30 years ago, they didn't have um none of these therapies. And unfortunately, they tended to do worse in comparison to a patient that is diagnosed with MS today.

SPEAKER_02 9:51

It's incredible how science has really improved the life of patients in every category, this, of course, being one of them. Now, this is an uncomfortable question because it's often uh searched but not often talked about. But what does advanced MS symptoms look like and how do care teams support the patient?

SPEAKER_00 10:08

Advanced can mean different uh perpetion. Some patients they have a lot of uh bladder involvement and urinary symptoms, and that can be disabling and not have a lot of other symptoms. And other patients they can have difficulty walking, they might need a cane every time they go out, or they might need a walker, and that can be very disabling. Um, so it might be a combination of multiple symptoms. It's hard to say just by looking at the patient if they are disabled from this or if this is advanced MS. Um, even though you may see a patient walking, they might have what we talk about, the invisible symptoms that can be really disabling, uh, a lot of brain fog and fatigue. Um something that I tell my patients is that uh to have the conversation with the family and friends and explain how they are feeling, especially with the fatigue. Explain that they are trying, uh, but their body sometimes cannot take it. With the brain fog, um, the memory issues, have the conversation and telling them, hey, you need to not multitask and just tell me one thing at a time, make sure I'm understanding, because that's something that patients struggle a lot.

SPEAKER_02 11:18

There's a common myth online that these symptoms will always progress and they will lead to a disability. Is that the case? What does the reality look like, especially today with so many advances in medicine?

SPEAKER_00 11:29

What we know is that um there is some sort of progression in virtually almost every patient to a certain degree. Okay. Therapies, they have done a great job of stopping new lesions and to some degree the progression, uh, but not every patient is gonna get to that advanced stage. We are even seeing it less and less over the past 10 years with all the new therapies that we have had. And there is a lot of research going on in finding these new medicines that are gonna be targeting that progression. Um, they're in the investigational phase, but we are hopeful.

SPEAKER_02 12:08

And we should clear up that it's not necessarily a fatal disease.

SPEAKER_00 12:11

No, the mortality rate for MS is uh the same as a general population.

unknown 12:16

Yeah.

SPEAKER_02 12:17

There's another misconception that this affects older adults. Is that the case, or can younger people develop this? And if so, how early can we see the onset of multiple sclerosis?

SPEAKER_00 12:28

Actually, it's the other way around. It's uh a disease of young people. MS tends to develop around the 30s. That's the typical age from 20 to 40. Um, females are a little bit more affected than males, like three to one. But uh yes, I've seen MS developing older adults in the MS world. An older adult is more than 50 um and 60. But yeah, MS is uh uh a condition of uh young people.

SPEAKER_02 12:59

When we talk about treatments, what is a high frequency treatment for MS?

SPEAKER_00 13:05

Like high efficacy?

SPEAKER_02 13:06

Yes.

SPEAKER_00 13:07

Yeah, okay. Those are treatments that uh target certain parts of the immune system and that we know is implied in the pathology, what causes the new lesions. Um there are different ones. There are pills that you take daily, there are infusions, meaning through the vein, that you do go every month or every six months uh just to get the therapy and then forget about it until the next one. And there are injections that you do every month. Um there are different ones. We don't not only one, we have multiple.

SPEAKER_02 13:43

So you say you can potentially get this treatment and forget about it. So when we speak about flare-ups and relapses, is that how it presents?

SPEAKER_00 13:53

Yes. Um, and I like explaining that because um even in the medical community, flare-ups, uh, relapses, pseudo-relapses, yeah, so many different terms that we use. And we need to clarify there is something called flares or a relapse, which is a new spot of inflammation in the brain or in the spinal cord that causes new symptoms. And we are able to see that in the MRI. And let's say a flare-up or a pseudo flare. Um, that means all symptoms that are coming back, either because there's an infection, then there might be stress, and those are not necessarily related to uh the MS getting worse. It just means that uh the body is under stress and um is fighting something else instead of compensating for the all symptoms. Um yeah, so you have two types of exacerbation in MS patients.

SPEAKER_02 14:51

Is this something that is curable or preventable? Is there something people can do to maybe not provoke those flare-ups?

SPEAKER_00 14:59

Not curable yet. Um, definitely working on it. Uh yes, there are a lot of things that patients can do to help their condition and uh uh mitigate all these symptoms. And it's uh similar to what we all hear. Stay healthy. Exercise. There's a lot of evidence that exercise helps a lot, not only the progression, but also the symptoms. Sleeping well, meditation, all those things can help. Um, again, sleeping uh with the symptoms and also the progression, not smoking. That is a big no-no in multiple sclerosis. Um, so those are things that people can continue.

SPEAKER_02 15:38

Why smoking specifically? We know it's so bad for the lungs, it's bad for the heart. Why specifically for MS?

SPEAKER_00 15:45

When um you smoke, there's a lot of uh um oxidants and a lot of chemicals that are really harmful, not just for the body, but for the brain, especially if it's a brain that already has some damage. It's like adding fire to the problem.

SPEAKER_02 16:04

Just to end on a hopeful note, someone that maybe has a diagnosis or knows of someone that has MS, uh, what can they, what can you tell them about living a long, healthy life?

SPEAKER_00 16:14

It's gonna depend, but I always emphasize that there's hope that uh the future of MS is advancing very rapidly and we are learning a lot. So what we know now in five years, five, ten years, we're gonna we're gonna learn more and we hopefully we're gonna have better treatment. And I have a lot of patients living a normal life, that they're working, they're functional, and with all the therapies that we have today, they can achieve that.

SPEAKER_02 16:44

Well, I hope you find that last piece of the puzzle. Um, and thank you so much because this conversation, whether or not we're affected by MS, it's important to know and understand what people are going through. I don't think I was aware of the fatigue and of maybe what someone's experiencing internally, and it's important when we want to be compassionate uh members of the society to understand what others are going through. So thank you so much for this conversation. It's really been invaluable. And thank you for sharing the insight with our audience. And to you, our viewers watching at home, remember your health matters. If this conversation was helpful, be sure to subscribe for more trusted guidance from Baptist Health Experts. You can also find Baptist Health Talk on Apple Podcasts, Spotify, or wherever you listen to podcasts.

SPEAKER_01 17:25

Thank you for watching. Find additional valuable health and wellness information on our resource blog at baptisthealth.net slash news. And be sure to interact with us on our social media channels for live and upcoming events. Baptist Health Talk is brought to you by Baptist Health, the warmer side of care.