Herpes simplex virus type 1 reactivation and antiviral therapy in patients with acute peripheral facial palsy.
OBJECTIVE
Recent studies provide compelling data for the hypothesis that herpes simplex virus type I (HSV-1) is implicated in the pathogenesis of idiopathic peripheral facial palsy (Bell's palsy). The present study analyzed the severity of facial palsy in patients with HSV-1 reactivation and sought to determine the efficacy of acyclovir-prednisone therapy for these patients.


METHODS
In total, 176 patients, clinically diagnosed with Bell's palsy. were divided into three groups by polymerase chain reaction (PCR) and serological tests--31 patients with HSV-1 reactivation, 45 patients with VZV reactivation (zoster sine herpete) and 100 patients without HSV-1 or VZV reactivation (Bell's palsy).


RESULTS
The difference in the worst grade of facial palsy between patients with zoster sine herpete and Bell's palsy was significant (P = 0.01 10, Mann-Whitney U-test). In contrast, no difference in the severity of palsy was observed between patients with HSV-1 reactivation and Bell's palsy. Twelve patients received acyclovir-prednisone treatment within 7 days of onset based on positive PCR results and ten of the 12 (83%) recovered completely. In contrast, 14 patients with HSV-1 reactivation received prednisone treatment because their PCR tests were performed at a later date; ten of these 14 (71%) recovered completely. The difference in the cure rate between the two treatment groups was not significant (P > 0.05, Fisher exact test).


CONCLUSIONS
The results indicate that the severity of palsy in patients with HSV-1 reactivation is similar to that in patients with Bell's palsy and suggest that early diagnosis of HSV-1 reactivation by PCR and subsequent acyclovir-prednisone therapy do not improve recovery from facial palsy.
Furuta
Y
Y
Department of Otolaryngology, Hokkaido University School of Medicine, Sapporo, Japan. yfuruta@med.hokudai.ac.jp
Ohtani
F
F
Chida
E
E
Mesuda
Y
Y
Fukuda
S
S
Inuyama
Y
Y
D000208:Acute Disease; D000212:Acyclovir / Q000627:therapeutic use*; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D000998:Antiviral Agents / Q000627:therapeutic use*; D020330:Bell Palsy / Q000188:drug therapy* / Q000821:virology*; D004359:Drug Therapy, Combination; D006561:Herpes Simplex / Q000150:complications / Q000209:etiology*; D018259:Herpesvirus 1, Human / Q000502:physiology; D006801:Humans; D008875:Middle Aged; D011241:Prednisone / Q000627:therapeutic use*; D012720:Severity of Illness Index; D014775:Virus Activation
D000893:Anti-Inflammatory Agents; D000998:Antiviral Agents; D011241:Prednisone; D000212:Acyclovir