Objective: To identify possible risk factors such as environmental exposures in subjects diagnosed with MSA from referral centres in Latin America (Pan-American MSA Study Group) and possible characteristics of this subcohort.

Background: MSA, a rare, progressive, adult-onset neurodegenerative disease, can cause a combination of symptoms including autonomic failure, parkinsonism, and pyramidal involvement. MSA is classified into three types according to the predominant motor involvement. MSA cerebellar (MSA-C), MSA parkinsonism (MSA-P) and MSA mixed.

Method: In 2014, we reported preliminary data from the PANMSA cohort to introduce knowledge in a specific Latin American region. Two years later, we implemented a restricted web-based database system to collect anonymous patient information in line with the global MSA registry standards. The registry includes demographic, epidemiological, phenotypic and imaging data.

Results: Our group presents 103 patients diagnosed with MSA. With demographic findings such as a mean age at presentation of 58.4 years and 55.5% being women, we can contribute with information about the Latin American population. The mean disease duration was 4.6 years. The mean UMSARS II score was 48, disease duration was 15 years and phenotypic subtypes were likely MSA-P 55%, likely MSA-C 15%, likely MSA-P 17% and likely MSA-C 13%.

10% of our sub-cohort with environmental exposures report exposure to pesticides, organic solvents or agricultural employment. The mean age at onset was 55 years, 70% were male and 60% had possible/probable MSA-C. The mean disease duration was 4.4 years, the mean UMSARS was 48.5 and all had disautonomias. All subjects reported dysphagia and dysphonia, but none reported cognitive impairment or amnesia. MRI results showed medial cerebellar atrophy in 20% and the hot cross bun sign in 40%.

Conclusion: Data on our population shows environmental exposures may link to early onset of the disease and certain variants. For this project, exposure assessments and a larger sample size are key.

Despite a shortage of pesticide exposure data in Latin America, the use of pesticides in agriculture, forestry, aquaculture and food production is increasing.Pesticide use in Latin America and the Caribbean is estimated at 20% of global use.

References: Casallanovo F, Simone DM, Santos GS, de Oliveira Kaminski TS, Cione AP, Peranginangin N. Estimating pesticide environmental concentrations in Latin America: The importance of developing local scenarios. Integr Environ Assess Manag. 2021 Sep;17(5):901-904. doi: 10.1002/ieam.4396. Epub 2021 Mar 15. PMID: 33491862.

S. Kab et al. Farming and incidence of motor neuron disease: French nationwide study European Journal of Neurology 2017, 0: 1–5 doi:10.1111/ene.13353

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