Journal of NeuroVirology

, Volume 16, Issue 1, pp 1–5

Herpes simplex virus type 1 and Bell’s palsy—a current assessment of the controversy

Mini Review

Abstract

Bell’s palsy causes about two thirds of cases of acute peripheral facial weakness. Although the majority of cases completely recover spontaneously, about 30% of cases do not and are at risk from persisting severe facial paralysis and pain. It has been suggested that herpes simplex virus type 1 (HSV-1) may be the etiological agent that causes Bell’s palsy. Although corticosteroid therapy is now universally recognized as improving the outcome of Bell’s palsy, the question as to whether or not a combination of antiviral agents and corticosteroids result in a better rate of complete facial recovery compared with corticosteroids alone is now a highly contentious issue. The evidence obtained from laboratory studies of animals and humans that HSV-1 may be linked to facial nerve paralysis is first outlined. The discussion then focuses on the results of different clinical trials of the efficacy of antiviral agents combined with corticosteroids in increasing the rate of complete recovery in Bell’s palsy. These have often given different results leading to opposite conclusions as to the efficacy of antivirals. Of three recent meta-analyses of previous trials, two concluded that antivirals produce no added benefit to corticosteroids alone in producing complete facial recovery, and one concluded that such combined therapy may be associated with additional benefit. Although it is probably not justified at the present time to treat patients with Bell’s palsy with antiviral agents in addition to corticosteroids, it remains to be shown whether antivirals may be beneficial in treating patients who present with severe or complete facial paralysis.

Keywords

aciclovir antiviral agents Bell’s palsy herpes simplex virus type 1 

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References

  1. Baringer JR (1974). Recovery of herpes simplex virus from human sacral ganglions. N Engl J Med 291: 828–830.PubMedCrossRefGoogle Scholar
  2. Baringer JR, Swoveland P (1973). Recovery of herpes simplex virus from human trigeminal ganglions. N Engl J Med 288: 648–650.PubMedCrossRefGoogle Scholar
  3. Bastian FO, Rabson AS, Yee CL (1972). Herpesvirus hominis: isolation from human trigeminal ganglion. Science 178: 306–307.PubMedCrossRefGoogle Scholar
  4. Davenport RJ, Sullivan F, Smith B, Morrison J, McKinstry B (2008). Treatment for Bell’s palsy. Lancet 372: 1219–1220.PubMedCrossRefGoogle Scholar
  5. De Almeida JR, Al Khabori M, Guyatt GH, Witterick IJ, Lin VYW, Nedzelski JM, Chen JM (2009). Combined corticosteroid and antiviral treatment for Bell palsy. A systematic review and meta-analysis. JAMA 302: 985–993.PubMedCrossRefGoogle Scholar
  6. Engstrom M, Berg T, Stjernquist-Desatnik A, Axelsson S, Pitkaranta A, Hultcrantz M, Kanerva M, Hanner P, Jonsson L (2008). Prednisolone and valaciclovir in Bell’s palsy: a randomised, double-blind, placebo-controlled, multicentre trial. Lancet (Neurol) 7: 993–1000.CrossRefGoogle Scholar
  7. Engstrom M, Berg T, Stjernquist-Desatnik A, Axelsson S, Pitkaranta A, Hultcrantz M, Kanerva M, Hanner P, Jonsson L (2009). Is antiviral medication for severe Bell’s palsy still useful? Authors’ reply. Lancet (Neurol) 8: 509–510.CrossRefGoogle Scholar
  8. Furuta Y, Takasu T, Sato KC, Fukuda S, Inuyama Y, Nagashima K (1992). Latent herpes simplex virus type 1 in human geniculate ganglia. Acta Neuropathol 84: 39–44.PubMedCrossRefGoogle Scholar
  9. Gilden D (2008). Treatment of Bell’s palsy—the pendulum has swung back to steroids alone. Lancet (Neurol) 7: 976–977.CrossRefGoogle Scholar
  10. Gilden DH, Tyler KL (2007). Bell’s palsy—is glucocorticoid treatment enough? N Engl J Med 357: 1653–1655.PubMedCrossRefGoogle Scholar
  11. Gilden DH, Wright RR, Schneck SA, Gwaltney JM Jr, Mahalingam R (1994). Zoster sine herpete, a clinical variant. Ann Neurol 35: 530–533.PubMedCrossRefGoogle Scholar
  12. Hato N, Murakami S, Gyo K (2008). Steroid and antiviral treatment for Bell’s palsy. Lancet 371: 1818–1820.PubMedCrossRefGoogle Scholar
  13. Hato N, Yamada H, Kohno H, Matsumoto S, Honda N, Gyo K, Fukuda S, Furuta Y, Ohtani F, Aizawa H, Aoyagi M, Inamura H, Nakashima T, Nakata S, Murakami S, Kiguchi J, Yamano K, Takeda T, Hamada M, Yamakawa K (2007). Valacyclovir and Prednisolone treatment for Bell’s palsy: a multicenter, randomized, placebo-controlled study. Otol Neurotol 28: 408–413.PubMedCrossRefGoogle Scholar
  14. Kawaguchi K, Inamura H, Abe Y, Koshu H, Takashita E, Muraki Y, Matsuzaki Y, Nishimura H, Ishikawa H, Fukao A, Hongo S, Aoyagi M (2006). Reactivation of herpes simplex virus type-1 and varicella-zoster virus and therapeutic effects of combination therapy with prednisolone and Valacyclovir in patients with Bell’s palsy. Laryngoscope 117: 147–156.CrossRefGoogle Scholar
  15. Kennedy PGE, Al-Saadi SA, Clements GB (1983). Reactivation of latent herpes simplex virus from dissociated identified dorsal root ganglion cells in culture. J Gen Virol 64: 1629–1635.PubMedCrossRefGoogle Scholar
  16. Lockhart P, Daly F, Pitkethly M, Comerford N, Sullivan F (2008). Antiviral treatment for Bell’s palsy (idiopathic facial paralysis). Cochrane Database Syst Rev (4): Art. No.: CD001869. DOI: 10.1002/14651858.CD001869.pub4.Google Scholar
  17. Mitchell BM, Bloom DC, Cohrs RJ, Gilden DH, Kennedy PGE (2003). Herpes simplex virus-1 and varicella-zoster virus latency in ganglia. J NeuroVirol 9: 194–204.PubMedGoogle Scholar
  18. Murakami S, Mizobuchi M, Nakashiro Y, Doi T, Hato N, Yanagihara N (1996). Bell palsy and herpes simplex virus: identification of viral DNA in endoneurial fluid and muscle. Ann Intern Med 124: 27–30.PubMedGoogle Scholar
  19. Quant EC, Jeste SS, Muni RH, Cape AV, Bhussar MK, Peleg AY (2009). The benefits of steroids versus steroids plus antivirals for treatment of Bell’s palsy: a meta-analysis. BMJ 339: 1–7.CrossRefGoogle Scholar
  20. Schultz P, Arbusow V, Strupp M, Dieterich M, Rauch E, Brandt T (1998). Highly variable distribution of HSV-1 specific DNA in human geniculate, vestibular and spiral ganglia. Neurosci Lett 14: 139–142.CrossRefGoogle Scholar
  21. Steiner I, Kennedy PGE (1995). Herpes simplex virus latent infection in the nervous system. J NeuroVirol 1: 19–29.PubMedCrossRefGoogle Scholar
  22. Steiner I, Spivack JG, Lirette RP, Brown SM, MacLean AR, Subak-Sharpe JH, Fraser NW (1989). Herpes simplex virus type 1 latency-associated transcripts are evidently not essential for latent infection. EMBO J 8: 505–511.PubMedGoogle Scholar
  23. Sullivan F, Swan I, Daly F (2008). Prednisolone or acyclovir in Bell’s palsy. Authors’ Reply. N Engl J Med 358: 307.Google Scholar
  24. Sullivan FM, Swan IRC, Donnan PT, Morrison JM, Smith BH, McKinstry B, Davenport RJ, Vale LD, Clarkson JE, Hammersley V, Hayavi S, McAteer A, Stewart K, Daly F (2007). Early treatment with prednisolone or acyclovir in Bell’s palsy. New Engl J Med 357: 1598–1606.PubMedCrossRefGoogle Scholar
  25. Thompson RL, Sawtell NM (2001). Herpes simplex virus type 1 latency-associated transcript gene promotes neuronal survival. J Virol, 75: 6660–6675.PubMedCrossRefGoogle Scholar
  26. Takasu T, Furuta Y, Sato KC, Fukuda S, Inuyama Y, Nagashima K (1992). Detection of latent herpes simplex virus DNA and RNA in human geniculate ganglia by the polymerase chain reaction. Acta Otolaryngol 112(6): 1004–1011.PubMedCrossRefGoogle Scholar
  27. Wakisaka H, Hato N, Honda N, Takahashi H, Kisaki H, Murakami S, Gyo K, Mominoki K, Kobayashi N, Matsuda S (2002). Demyelination associated with HSV-1-induced facial paralysis. Exp Neurol 178: 68–79.PubMedCrossRefGoogle Scholar
  28. Warren KG, Devlin M, Gilden DH, Wroblewska Z, Koprowski H, Brown SM, Subak-Sharpe J (1978) Herpes simplex virus latency in patients with multiple sclerosis, lymphoma and normal humans. In: Oncogenesis and herpesvirus III, part 2: cell-virus interactions, host response to herpesvirus infection and associated tumors, role of co-factors. de-The G, Henle W, Rapp R (eds). Lyon, France: International Agency for Research on Cancer, pp 765–768.Google Scholar

Copyright information

© Journal of NeuroVirology, Inc. 2010

Authors and Affiliations

  1. 1.Department of Neurology, Division of Clinical Neurosciences, Faculty of MedicineUniversity of Glasgow, Institute of Neurological Sciences, Southern General HospitalGlasgowUK

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