IS BELLS-PALSY A REACTIVATION OF VARICELLA-ZOSTER VIRUS

Despite various pointers to an infectious aetiology, the cause of Bell 's palsy remains obscure. We examined paired sera from 62 patients wit h facial palsy and 50 age and sex matched contemporaneous controls. Si gnificantly more patients than controls had IgM antibodies by ELISA to varicella tester virus (56.5% vs. 20%, P = 0.0001) and herpes simplex virus (41.9% vs. 18%, P = 0.006). Additionally, significantly more pa tients than controls were positive for CF antibody to varicella tester virus (14.5% vs. O%, P = 0.004) but not to herpes simplex or cytomega lovirus, Significantly more controls than patients (54% vs, 25.8%, P = 0.002) had no evidence of antigenic stimulation by any member of the herpesvirus group. No significant difference between patients and cont rols in seropositivity by ISM ELISA to cytomegalovirus, Epstein-Barr v irus and IFA for human herpes virus 6 was found, Furthermore, there wa s no significant difference between the two groups as to evidence of r ecent infection by the following agents: rubella virus and Borrelia bu rgdorferi by IgM ELISA, influenza A, influenza B, adenovirus, respirat ory syncytial virus, mumps and measles, Mycoplasma pneumoniae, Coxiell a burnetii and chlamydia spp. by complement fixation test. The first r eported case of clinically and serologically proven Mycoplasma pneumon iae pneumonia associated with Bell's palsy is described. The rate of c omplete recovery at 6-8 weeks after onset was not significantly differ ent in patients who were given steroids compared to those who were not . Ear related symptoms were the most common, occurring in 12 of 65 cas es, but only three (4.6%) had clinical shingles (vesicles in ear). The above data suggest that as in Ramsay Hunt syndrome, reactivation of v aricella tester virus may constitute the 'final common pathway' in the pathogenesis of Bell's palsy and that the latter is in effect a manif estation of tester sine herpete. Further studies are needed to determi ne the pathogenesis of facial nerve damage as well as the benefit, if any, of early acyclovir therapy on the course and outcome of Bell's pa lsy.