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 1 (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. Materials and 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-I 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 tester 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-I 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-I 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. (C) 2001 Elsevier Science Ireland Ltd. All rights reserved.