Levamisole-associated multifocal inflammatory encephalopathy: clinical and MRI characteristics, and diagnostic...

Area of Science:

• Neurology
• Neuroimmunology
• Toxicology

Background:

• Levamisole (LEV) is misused as an anthelmintic, leading to Levamisole-associated multifocal inflammatory encephalopathy (LAMIE).
• LAMIE is frequently misdiagnosed as multiple sclerosis (MS) or acute disseminated encephalomyelitis (ADEM).

Purpose of the Study:

• To characterize the clinical, laboratory, and morphological features of LAMIE.
• To define magnetic resonance imaging (MRI) patterns associated with LAMIE.
• To develop a differential diagnosis algorithm for LAMIE.

Main Methods:

• Prospective observational study with retrospective analysis.
• Inclusion of 43 LAMIE patients with 1-5 year follow-up.
• Analysis of clinical data, cerebrospinal fluid (CSF) analysis, MRI, and brain biopsy.

Main Results:

• Typical LAMIE symptoms include cerebellar, pyramidal, and cognitive deficits, often with a biphasic disease course.
• Three MRI patterns were identified: ADEM-like, MS-like, and atypical demyelination.
• Elevated CSF albumin and IgG index were observed; 40% showed oligoclonal bands, but only 20% converted to MS within 2 years.

Conclusions:

• LAMIE presents with diverse clinical and MRI findings, frequently mimicking MS or ADEM.
• A biphasic disease course and specific MRI patterns aid in LAMIE diagnosis.
• Consider LAMIE in patients with inflammatory or demyelinating conditions exhibiting biphasic onset and variable MRI presentations.