Clinical research studySteroid-antiviral Treatment Improves the Recovery Rate in Patients with Severe Bell's Palsy
Section snippets
Methods
Between September 2008 and August 2011, we conducted a prospective, randomized study of patients who visited our tertiary medical center due to acute unilateral peripheral facial paralysis without skin lesions or intraoral lesions occurring within 7 days of presentation. The House-Brackmann grading system was used to evaluate the severity of facial palsy, and only patients with severe to complete Bell's palsy (House-Brackmann grade ≥5) were enrolled.9
All patients were hospitalized for 1 week.
Results
A total of 269 patients were enrolled in this study. After excluding 32 patients who did not match the inclusion criteria and 31 patients who did not complete this study due to adverse effects of treatment and did not present for follow-up, 206 patients completed the study (Figure 1).
The steroid treatment group (S group) comprised 107 patients, and the combination treatment group (S+A group) comprised 99 patients. There was no significant difference in the distribution of facial grades between
Discussion
Additional antiviral treatment in Bell's palsy is based on the hypothesis that herpes simplex virus infection may cause inflammation of the facial nerve. Theoretically, the infectious agents are eradicated by antiviral treatment, and swelling of the facial nerve is reduced by corticosteroids.6 However, antiviral agents cannot actually destroy virus that has already replicated, because these drugs prevent viral replication by interfering with viral DNA polymerase. In this respect, Hato et al
References (28)
- et al.
Acyclovir plus steroid vs steroid alone in the treatment of Bell's palsy
Am J Otolaryngol
(2008) - et al.
Prednisolone and valaciclovir in Bell's palsy: a randomised, double-blind, placebo-controlled, multicentre trial
Lancet Neurol
(2008) - et al.
Analysis of prognostic factors in Bell's palsy and Ramsay Hunt syndrome
Auris Nasus Larynx
(2007) Bell's palsy: the spontaneous course of 2,500 peripheral facial nerve palsies of different etiologies
Acta Otolaryngol Suppl
(2002)Incidence of Bell's palsy
Ann Otol Rhinol Laryngol Suppl
(1988)- et al.
Bell palsy and herpes simplex virus: identification of viral DNA in endoneural fluid and muscle
Ann Intern Med
(1996) - et al.
The management of peripheral facial nerve palsy: “paresis” versus “paralysis” and sources of ambiguity in study designs
Otol Neurotol
(2010) - et al.
Early treatment with prednisolone or acyclovir in Bell's palsy
N Engl J Med
(2007) - et al.
Antiviral treatment for Bell's palsy (idiopathic facial paralysis)
Cochrane Database Syst Rev
(2009) - et al.
Valacyclovir and prednisolone treatment for Bell's palsy: a multicenter, randomized, placebo-controlled study
Otol Neurotol
(2007)
Bell's palsy: combined treatment of famciclovir and prednisone is superior to prednisone alone
J Neurol
Facial nerve grading system
Otolarynogol Head Neck Surg
AciclovirA reappraisal of its antiviral activity, pharmacokinetic properties and therapeutic efficacy
Drugs
Idiopathic facial paralysis: a randomized, prospective, and controlled study using single-dose prednisone versus acyclovir three times daily
Laryngoscope
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Funding: This research was supported by the Kyung Hee University Research Fund in 2011(KHU-2011-1098).
Conflict of Interest: None.
Authorship: All authors had full access to the data and played a role in writing this manuscript.