This study aimed to identify the clinical significance of iron rim lesions (IRLs) in distinguishing multiple sclerosis (MS) from other central nervous system (CNS) demyelinating diseases, determine the relationship between IRLs and disease severity, and understand the long-term dynamic changes in IRLs in MS. We retrospectively evaluated 76 patients with CNS demyelinating diseases. CNS demyelinating diseases were classified into three groups: MS (n = 30), neuromyelitis optica spectrum disorder (n = 23), and other CNS demyelinating diseases (n = 23). MRI images were obtained using conventional 3T MRI including susceptibility-weighted imaging. Sixteen of 76 patients (21.1%) had IRLs. Of the 16 patients with IRLs, 14 were in the MS group (87.5%), indicating that IRLs were significantly specific for MS. In the MS group, patients with IRLs had a significantly higher number of total WMLs, experienced more frequent recurrence, and were treated more with second-line immunosuppressive agents than were patients without IRLs. In addition to IRLs, T1-blackhole lesions were observed more frequently in the MS group than in the other groups. IRLs are specific for MS and could represent a reliable imaging biomarker to improve the diagnosis of MS. Additionally, the presence of IRLs seems to reflect more severe disease progression in MS.

Noninvasive stimulation of the nervous system for treating chronic neuropathic pain has received attention because of its tolerability and relative efficacy. Repetitive transcranial magnetic stimulation (rTMS) is a representative method of noninvasive brain stimulation. Evidence-based guidelines on therapeutic use of rTMS have been proposed recently for several neurological diseases. These guidelines recommend treating neuropathic pain by applying high-frequency (≥ 5 Hz) rTMS to the primary motor cortex contralateral to the painful side. This review summarizes the mechanisms and guidelines of rTMS for treating neuropathic pain, and proposes directions for future research.

Kim S, et al. J Korean Med Sci. 2023 Feb;38(8):e57. https://doi.org/10.3346/jkms.2023.38.e57

Purpose: Autonomic dysfunction is a common but frequently overlooked manifestation of systemic diseases. Because early manifestations are often nonspecific, including dizziness, fatigue, palpitations, exercise intolerance, and gastrointestinal dysmotility, clinicians need a structured approach to support timely recognition and risk stratification.Current concepts: Systemic disorders affect autonomic regulation through overlapping mechanisms, including metabolic injury, microvascular dysfunction, chronic inflammation, and impaired cardiovascular reflex control. In diabetes, autonomic nerve injury accumulates over time, and cardiovascular autonomic neuropathy is associated with increased cardiovascular events and mortality. In chronic kidney disease, persistent sympathetic activation, reduced vagal modulation, and baroreflex impairment contribute to hypertension, intradialytic hypotension, and arrhythmic risk. In heart failure and ischemic heart disease, sympathetic predominance and vagal withdrawal accelerate disease progression and are associated with malignant ventricular arrhythmias and sudden cardiac death. Systemic autoimmune disorders are also associated with impaired cardiovascular reflex control and small-fiber neuropathy.Discussion and conclusion: A practical evaluation begins with symptom screening and review of medications and comorbidities, followed by standardized autonomic testing. Cardiovascular autonomic reflex tests, together with scoring tools such as the composite autonomic scoring scale, help quantify the distribution and severity of autonomic involvement and support longitudinal monitoring. Management should integrate optimal control of the underlying systemic disease, non-pharmacological measures for orthostatic intolerance, and symptom-directed treatment for orthostatic hypotension.

Gradual progressive weakness in a patient with diabetes mellitus can be caused by several conditions, including myelopathy, motor neuron disease, chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), and myopathy. Diagnosing the exact cause of progressive muscle weakness can be challenging in the presence of diabetic polyneuropathy (DPN). We report a case of CIDP with DPN in a 64-year-old woman who was initially misdiagnosed with amyotrophic lateral sclerosis. This case also demonstrates the importance of using the correct dose and duration for the treatment of CIDP.

Kim S, et al. J Korean Med Sci. 2026 Nov;41:e287. https://doi.org/10.3346/jkms.2026.41.e287