Pathophysiology and Mechanism of Bell's Palsy ; Early Diagosis and Treatment.

近年来，单纯疱疹1型作为贝尔麻痹的原因的证据越来越多。在本研究中，我们已经证明了由HSV-1感染引起的面神经麻痹的机制和病理生理使用动物模型。组织学上，受累面神经严重肿胀，炎性细胞浸润，空泡变性。HSV-1不仅感染雪旺氏细胞，还感染神经细胞和星形胶质细胞。面神经干内混杂有完整的、脱髓鞘的和变性的神经纤维。电生理学研究表明，瞬目反射试验中R1潜伏期的时程对面神经麻痹的恢复有良好的预测作用，而ENoG的恢复则有延迟的趋势，这些反应通常见于Bell麻痹。我们还进行了病毒DNA检测从贝尔的病人的唾液。HSV-1DNA检出率为16%，VZV检出率为9%。对480例贝尔病患者进行了回顾性评价。总回收率为95.7%。在发病后3天内开始这种治疗的患者的比率为100%。这些结果表明，早期治疗是必要的有效的阿昔洛韦-泼尼松治疗贝尔麻痹。

Evidence of herpes simplex type 1 as a cause of Bell's palsy has been more and more increasing in recent years. In the present study, we have demonstrated the mechanism and pathophysiology of facial nerve palsy caused by HSV-1 infection using animal model. Histopathologically, severe nerve swelling, inflammatory cell infiltration and vacuolar degeneration in the affected facial nerve. HSV-1 was infected not only Shwann cells but also nerve cell and astrocyte. Many kind of nerve fibers, intact, demyelinated, and degenerated, were intermingled in the facial nerve trunk. Electro physiological study has demonstrated that the time course of R1 latency in the blink reflex tests paralleled the recovery of the facial nerve paralysis well, whereas ENoG recovery tended to be delayed, compared to that of the paralysis ; these responses are usually seen in Bell's palsy. We also performed the detection of viral DNA from saliva of Bell's patient. HSV-1DNA was detected in 16% of the patients and VZV was from 9% of the patients. The effect of acyclovir-prednisone treatment was also evaluated retrospectively in 480 Bell's patients. The overall recovery rate was 95.7%. The rate in patients who started this treatment within 3 days after onset was 100%. These results suggest that early treatment is necessary for effective acyclovir-prednisone therapy in Bell's palsy.