Clinical and virological study on Bell's palsy

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1.Bell's palsy treatment with prednisolone and valaciclovirWe performed a multi-center prospective, randomized study between Sep.2002 and Dec.2004. The subjects, who were within one week of the onset of Bell's palsy and who had not yet been treated, were randomly allocated to one of two groups ; one with oral administration of prednisolone (60 mg/day tapering 10 days) alone and the other in a combined treatment group with an anti-viral agent (valaciclovir, 1000 mg/day, 5 days). The final results of these therapeutic regimens were compared. Of a total 143 patients, 63 received prednisolone alone and 80 received prednisolone plus valaciclovir. In the group treated with prednisolone alone, 54 of 63 patients were judged to have recovered, while for the group treated with the valaciclovir combination, 72 of the 80 patients were judged to have been cured. The recovery rates for the prednisolone-treated and valaciclovir combination groups were 85.7 and 90.0%, respectively. Among the patients … More with complete paralysis (a palsy score lower than 8 on the 40-point Japanese grading system), the recovery rates were 77.8% and 79.3%, respectively. The above-mentioned results show that the recovery rates were the same in both treatment groups.2.A virological evaluation of patients with Bell's palsyTo detect reactivation of herpes simplex virus type-1 (HSV-1) and varicella zoster virus (VZV) in patients with Bell's palsy, we performed virological assay. Materials and Methods : 106 patients who had given a diagnosis of clinical Bell's palsy were enrolled in this study. Patients with Ramsay Hunt syndrome were excluded. We examined antibody titers against HSV and VZV by highly sensitive enzyme immunoassay, viral DNA detection in saliva by real-time PCR and virus isolation by cell culture. Results : Reactivation of HSV-1 was detected in 12 patients (11.3%). Reactivation of VZV was detected in 16 patients (15.1%). Furthermore, reactivation of both viruses was detected in 5 patients (4.7%).Conclusions : It is difficult to detect reactivation of these viruses using only serological assay and virus isolation at the onset of Bell's palsy. However, pair serological study and real-time PCR were effective in detecting these viral reactivations. Although the cause of Bell's palsy is controversial, reactivation of HSV-1 and VZV may be the major cause of Bell's palsy. Our results suggest that reactivation of these viruses is induced after the onset of Bell's palsy in some patients. Less