Herpes simplex virus type 1 reactivation and antiviral therapy in patientswith acute peripheral facial palsy

Objective: Recent studies provide compelling data for the hypothesis that h erpes simplex virus type 1 (HSV-1) is implicated in the pathogenesis of idi opathic 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 patien ts. Materials and methods: In total, 176 patients, clinically diagnosed wit h Bell's palsy, were divided into three groups by polymerase chain reaction (PCR) and serological tests - 31 patients with HSV-I reactivation, 45 pati ents with VZV reactivation (zoster sine herpete) and 100 patients without H SV-1 or VZV reactivation (Bell's palsy). Results: The difference in the wor st 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, n o difference in the severity of palsy was observed between patients with HS V-I reactivation and Bell's palsy. Twelve patients received acyclovir-predn isone treatment within 7 days of onset based on positive PCR results and te n of the 12 (83%) recovered completely. In contrast, 14 patients with HSV-I reactivation received prednisone treatment because their PCR tests were pe rformed at a later date; ten of these 14 (71%) recovered completely. The di fference in the cure rate between the two treatment groups was not signific ant (P > 0.05, Fisher exact test). Conclusions: The results indicate that t he 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 re activation by PCR and subsequent acyclovir-prednisone therapy do not improv e recovery from facial palsy. (C) 2001 Elsevier Science Ireland Ltd. All ri ghts reserved.