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 (Bellʹs 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 Bellʹs palsy, were divided into three groups by polymerase chain reaction (PCR) and serological tests — 31 patients with HSV-1 reactivation, 45 patients with VZV reactivation (zoster sine herpete) and 100 patients without HSV-1 or VZV reactivation (Bellʹs palsy). Results: The difference in the worst grade of facial palsy between patients with zoster sine herpete and Bellʹs 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-1 reactivation and Bellʹs 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-1 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 Bellʹs palsy and suggest that early diagnosis of HSV-1 reactivation by PCR and subsequent acyclovir–prednisone therapy do not improve recovery from facial palsy.