Association of Statins with Sensory and Autonomic Ganglionopathy.
OBJECTIVE
To examine if statins have an effect on small nerve fibers.


METHODS
This retrospective study evaluated the effect of statins in pure small-fiber neuropathy (SFN). Outcome measures were symptom scales (numbness, tingling, and autonomic symptoms), skin biopsies assessing epidermal nerve fiber density (ENFD), sweat gland nerve fiber density (SGNFD), and quantitative autonomic testing.


RESULTS
One hundred and sixty participants with pure SFN were identified. Eighty participants (women/men, age ± SD 33/47, 68.1 ± 11.6 years old) were on statins for 53.5 ± 28.7 months to treat dyslipidemia and they were age and gender matched with 80 participants (33/47, 68.1 ± 9.5) that were off statins. ANOVA showed reduced ENFD/SGNFD at the proximal leg in the statin group [(count/mm) 8.3 ± 3.6/51.3 ± 14.2] compared to the off statin group (10.4 ± 3.8, p = 0.0008/56.4 ± 12.7, p = 0.018). There was no difference in ENFD/SGNFD at the distal leg in the statin group (4.9 ± 3.2/39.8 ± 15.7) compared to the off statin group (5.9 ± 3.4, p = 0.067/41.8 ± 15.9, p = 0.426). Statins did not affect symptom scales and the outcome of autonomic testing.


CONCLUSIONS
Statin use is associated with degeneration of sensory and autonomic fibers. The pattern of abnormalities, e.g., degeneration of proximal while sparing of distal fibers, is consistent with a non-length-dependent process with lesions in the dorsal root and the autonomic ganglia. The statin-associated sensory and autonomic ganglionopathy is mild.
Department of Neurology, University of Massachusetts Medical School , Worcester, MA , USA.
Peter
P
Novak
Department of Neurology, University of Massachusetts Medical School , Worcester, MA , USA ; Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School , Boston, MA , USA.
Daniela A
DA
Pimentel
Department of Neurology, University of Massachusetts Medical School , Worcester, MA , USA.
Banu
B
Sundar
Department of Neurology, University of Massachusetts Medical School , Worcester, MA , USA.
Majaz
M
Moonis
Department of Neurology, University of Massachusetts Medical School , Worcester, MA , USA.
Lan
L
Qin
Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School , Boston, MA , USA.
Vera
V
Novak
ganglionopathy; neuronopathy; small-fiber neuropathy; statin toxicity; statins