Early collection of saliva specimens from Bell's palsy patients: Quantitative analysis of HHV-6, HSV-1, and VZV

Abstract

Bell's palsy is the most common cause of facial paralysis. Although it has been associated with diabetes mellitus, hypertension, pregnancy, and preeclampsia, the etiology of Bell's palsy remains unknown. The reactivation of latent herpes simplex virus (HSV) or varicella-zoster virus (VZV) with subsequent inflammation and entrapment of the facial nerve in the narrow labyrinthine segment has been implicated as a cause of facial paralysis, but the active role of these viruses in Bell's palsy is still discussed. This study quantified HSV-1 DNA, VZV DNA, and HHV-6 DNA in 95 saliva samples collected from patients within 48 hr from the onset of paralysis. HSV-1, VZV, and HHV-6 were detected in 13%, 3%, and 61% of patients, respectively. The detection rate did not differ significantly between patients and a control group of healthy donors. Interestingly, however, the value of HHV-6 DNA copies was significantly higher than that detected in healthy donors. In addition, the mean value of HHV-6 DNA recorded in patients who had at least a one grade improvement of palsy at the first visit was significantly lower than that detected in patients who showed no change in facial palsy grade or an increase of at least one grade. These findings call into question the role of HSV-1 and VZV in the etiology of Bell's palsy, and suggest that HHV-6 may be involved in the development of the disease or that the underlying disease mechanism might predispose patients to HHV-6 reactivation.

Recovery in 61-Year-Old Male After Bell’s Palsy: A Case Report

“…Causes of unilateral peripheral facial nerve paralysis are various and include idiopathic, viral infection, vascular, autoimmune reactions, traumatic, surgical procedures and neoplastic [11,12]. Herpes viruses seemed to be the most possible infective agent [5,6]. Lower motor neurone (LMN) facial palsy is characterized by unilateral paralysis of all muscles of facial expression for both voluntary and emotional responses.…”

“…Corticosteroids have long been used in Bell's palsy because of their powerful anti-inflammatory effect, and have been proven to be an effective treatment. Studies showed evidence for the presence of herpes simplex virus in some cases of bell's palsy [5,6], thus anti-viral agents were applied in some cases. Approximately 70% of all patients recover completely, and a higher percentage of improvement is achieved if corticosteroid therapy is prescribed [14,15].…”

“…It affects people of all ages but, most commonly, individuals 15-50 years of age with equal sex prediction [3,4]. In majority of the cases, the cause is idiopathic and most patients improve completely with outpatient therapy in 3 weeks without complication [5,6].…”

Concurrent pityriasis rosea and Bell's palsy

“…A recent study demonstrates that patients with Bell's palsy have similar HSV and varicella levels, but significantly higher HHV-6 in saliva than controls. In addition, higher HHV-6 levels portend a slower recovery of facial paralysis 12. This evidence points in favour of a link between HHV-6 and Bell's palsy compared with other studied viruses, but more research needs to be performed to confirm these findings.…”

Herpes simplex virus 2 infection: molecular association with HIV and novel microbicides to prevent disease

“…1). Though HSV-1 is frequently referred as one of the causative agents of this disease [42,43], other viruses, such as the human herpesvirus-6, have also been proposed to be involved in the onset of this form of facial paralysis [44,45].…”