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

Abstract

Reactivation of HSV-1 or VZV was observed in 34% of the patients with Bell's palsy. The effect of combination therapy with prednisolone and valacyclovir on recovery was not significantly higher than that with prednisolone alone.

Tipo de terapêutica e fatores de prognóstico na paralisia de Bell: estudo retrospectivo de cinco anos em um hospital português

“…A escolha da abordagem terapêutica para a paralisia de Bell continua a ser um problema comum na prática médica [12][13][14][15][16][17]. Os resultados deste estudo relativamente à terapêutica antiviral estão de acordo com a revisão Cochrane de 2015 [18], que incluiu 11 ensaios controlados, com um total de 2883 pacientes com paralisia de Bell.…”

Bell's palsy: new evidence provides a definitive drug therapy strategy

“…6 The second study (296 recruited) reported a positive outcome, 7 but this result was compromised by a number of serious methodological flaws, including an inadequate randomisation procedure, single blind design, and a 25% drop out rate (not included in the analyses). 8 Following the publication of these three trials in 2007, 4,6,7 some commentators still recommended the use valaciclovir for those with severe facial weakness, 9,10 despite the evidence of lack of effectiveness. Most recently, the Swedish study 5 has hopefully put the matter beyond doubt, with no evidence that valaciclovir was effective in the management of Bell's palsy.…”

“…Serological studies were carried out in the two Japanese studies and revealed evidence of varicella zoster reactivation in 23/296 (8%) 7 and 28/150 (19%). 6 The latter study also measured HSV serology which indicated reactivation in 29/150 (19%). 6 Antiviral enthusiasts suggest that because the dose of aciclovir used in the Scottish trial 4 was insufficient to treat varicella zoster and because patients were not tested serologically, unwitting inclusion of varicella zoster patients may have biased the study, producing an erroneous negative result.…”

“…6 The latter study also measured HSV serology which indicated reactivation in 29/150 (19%). 6 Antiviral enthusiasts suggest that because the dose of aciclovir used in the Scottish trial 4 was insufficient to treat varicella zoster and because patients were not tested serologically, unwitting inclusion of varicella zoster patients may have biased the study, producing an erroneous negative result. However, this argument is insufficient to explain the lack of effect seen in the Swedish study, 5 as the dose of valaciclovir (3000 mg/day for 7 days) was sufficient to treat varicella zoster as well as HSV (serology was not performed).…”

“…After decades of little persuasive evidence, four randomised controlled trials, involving over 1800 patients, have recently been published, and their results allow much more robust conclusions regarding drug treatment of Bell's palsy. [4][5][6][7] Steroids definitely improve outcome, based on the results of two large primary care based trials which addressed this question. The Scottish Bell's palsy trial 4 included 551 patients recruited from primary care, and showed that 83% of patients treated with prednisolone within 72 hours of onset (50 mg/day for 10 days) had recovered compared to 63.6% who received placebo at 3 months (number needed to treat [NNT] = 6) and this result remained significant at 9 months (NNT = 8).…”