Reactivation of herpes simplex virus type 1 and varicella-zoster virus and therapeutic effects of combination therapy with prednisolone and valacyclovir in patients with Bell's palsy.
OBJECTIVE
To determine whether reactivation of herpes simplex virus (HSV) type 1 or varicella-zoster virus (VZV) is the main cause of Bell's palsy and whether antiviral drugs bring about recovery from Bell's palsy.


METHODS
Randomized, multicenter, controlled study.


METHODS
One hundred fifty patients with Bell's palsy were enrolled in this study. The patients were randomly assigned to a prednisolone group or a prednisolone-valacyclovir group, in whom virologic examinations for HSV-1 and VZV were performed by simple randomization scheme in sealed envelopes. The recovery rates among various groups were analyzed using the Kaplan-Meier method and the Cox proportional hazards model.


RESULTS
Reactivation of HSV-1, VZV, and both viruses was detected in 15.3%, 14.7%, and 4.0% of patients, respectively. There was no significant difference in recovery rates between the prednisolone group and the prednisolone-valacyclovir group, although recovery in the patients with HSV-1 reactivation tended to be higher in the prednisolone-valacyclovir group than in the prednisolone group. There was a significant difference in recovery among age groups and between individuals with complete and incomplete paralysis.


CONCLUSIONS
Reactivation of HSV-1 or VZV was observed in 34% of the patients with Bell's palsy. The effect of combination therapy with prednisolone and valacyclovir on recovery was not significantly higher than that with prednisolone alone.
Kawaguchi
Kazuhiro
K
Department of Otolaryngology, Yamagata University School of Medicine, Yamagata, Japan. kazukawa@med.id.yamagata-u.ac.jp
Inamura
Hiroo
H
Abe
Yasuhiro
Y
Koshu
Hidehiro
H
Takashita
Emi
E
Muraki
Yasushi
Y
Matsuzaki
Yoko
Y
Nishimura
Hidekazu
H
Ishikawa
Hitoshi
H
Fukao
Akira
A
Hongo
Seiji
S
Aoyagi
Masaru
M
D000212:Acyclovir / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D000906:Antibodies / Q000097:blood; D000998:Antiviral Agents / Q000627:therapeutic use*; D020330:Bell Palsy / Q000188:drug therapy* / Q000209:etiology / Q000276:immunology / Q000821:virology; D004359:Drug Therapy, Combination; D005260:Female; D018259:Herpesvirus 1, Human / Q000276:immunology / Q000502:physiology*; D014645:Herpesvirus 3, Human / Q000276:immunology / Q000502:physiology*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011239:Prednisolone / Q000627:therapeutic use*; D016016:Proportional Hazards Models; D016896:Treatment Outcome; D000077483:Valacyclovir; D014633:Valine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D014775:Virus Activation / Q000502:physiology
D000893:Anti-Inflammatory Agents; D000906:Antibodies; D000998:Antiviral Agents; D011239:Prednisolone; D014633:Valine; D000077483:Valacyclovir; D000212:Acyclovir