Idiopathic diaphragmatic paralysis: Bell's palsy of the diaphragm?
OBJECTIVE
Idiopathic diaphragm paralysis is probably more common and responsible for more morbidity than generally appreciated. Bell's palsy, or idiopathic paralysis of the seventh cranial nerve, may be seen as an analogous condition. The roles of zoster sine herpete and herpes simplex have increasingly been recognized in Bell's palsy, and there are some data to suggest that antiviral therapy is a useful adjunct to steroid therapy. Thus, we postulated that antiviral therapy might have a positive impact on the course of acute idiopathic diaphragm paralysis which is likely related to viral infection.


METHODS
Three consecutive patients with subacute onset of symptomatic idiopathic hemidiaphragm paralysis were empirically treated with valacyclovir, 1,000 mg twice daily for 1 week. Prior to therapy, diaphragmatic function was assessed via pulmonary function testing and two-dimensional B-mode ultrasound, with testing repeated 1 month later. Diaphragmatic function pre- and post-treatment was compared to that of a historical control group of 16 untreated patients.


RESULTS
All three subjects demonstrated ultrasound recovery of diaphragm function 4-6 weeks following treatment with valacyclovir. This recovery was accompanied by improvements in maximum inspiratory pressure (PI(max)) and vital capacity (VC). In contrast, in the untreated cohort, diaphragm recovery occurred in only 11 subjects, taking an average of 14.9 +/- 6.1 months (mean +/- SD).


CONCLUSIONS
The results of this small, preliminary study suggest that antiviral therapy with valacyclovir may be helpful in the treatment of idiopathic diaphragm paralysis induced by a viral infection.
Crausman
Robert S
RS
Warren Alpert Medical School of Brown University, Providence, RI 02912, USA. Robert_Crausman@Brown.edu
Summerhill
Eleanor M
EM
McCool
F Dennis
FD
D000212:Acyclovir / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000368:Aged; D000369:Aged, 80 and over; D000998:Antiviral Agents / Q000627:therapeutic use*; D020330:Bell Palsy / Q000188:drug therapy* / Q000821:virology; D003964:Diaphragm / Q000000981:diagnostic imaging / Q000187:drug effects* / Q000503:physiopathology / Q000821:virology; D005260:Female; D006801:Humans; D001239:Inhalation; D008875:Middle Aged; D010865:Pilot Projects; D020127:Recovery of Function; D012133:Respiratory Paralysis / Q000188:drug therapy* / Q000503:physiopathology / Q000821:virology; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography; D000077483:Valacyclovir; D014633:Valine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D014797:Vital Capacity
D000998:Antiviral Agents; D014633:Valine; D000077483:Valacyclovir; D000212:Acyclovir