Objective: To describe the clinical features of 7 New York City Metropolitan Transit Authority (NYC MTA) rail-track workers with Parkinson’s disease (PD) presenting to a NYC Movement Disorders center.

Background: Many environmental toxicants have been recognized as significant factors for the development of PD. NYC MTA rail-track workers are exposed to multiple toxicants, including pesticides, dust metals, lubricants, and other pollutants. Many of these have the potential to cause PD in genetically-predisposed hosts. We should recognize vulnerable populations with possible work-related toxicant exposure and institute surveillance and safety measures to prevent the development of PD.

Method: A retrospective chart review of 7 former MTA rail-track workers who had presented to our center was performed. Data related to disease presentation, progression, medication responsiveness, and complications were abstracted from charts.

Results: 7 former MTA rail-track employees (6 track workers, 1 track supervisor, 6 male, 1 female, mean age 58.6±10.6y) with mean duration 21.0±8.9y of track work developed Parkinsonism (mean age of PD diagnosis 53.4±11.7y). All subjects initially presented with right-sided symptoms of bradykinesia (n=5) or tremor (n=2). Upon review of DAT scans (n=5), there was a significant bilateral decrease in dopamine transporter uptake in the corpus striatum. Subjects (n≥5) exhibited prodromal manifestations: REM-Sleep Behavior Disorder, bladder and bowel dysfunction, and depression. Since the initial visit, subjects (n≥5) have also developed non-motor/motor parkinsonian features such as cognitive impairment, insomnia, hypophonia, dysarthria, and motor freezing. The time of PD onset to work disability ranged from 2wks to 2y. At present, all patients remain Levodopa responsive, which includes 1 bilateral DBS placement.

Conclusion: Here, we describe the clinical features of 7 NYC MTA rail-track workers of a relatively young age afflicted with PD who had a rapidly progressive course leading to early disability. The development of PD in this cohort of patients is likely related to the multiple toxicants in their former working environment. A broader study to be undertaken in this vulnerable patient population to isolate the possible causative agents and to take the necessary precautions for reducing long-term exposure to these elements. We recommend all NYC MTA rail-track workers should be screened for prodromal and early manifestations of PD.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/are-new-york-city-rail-tracks-harbingers-for-parkinsons-disease/