LETTER RE: Bell's palsy treatment strategies: Antivirals may help some patients
Richard B.Tenser, Penn State University College of Medicine, Hershey, PArtenser@psu.edu
Submitted June 20, 2014
The suggested use of antivirals1 in the treatment
of Bell's palsy is probably not supported by basic science
or clinical science data. Herpes simplex virus (HSV) latent
infection of trigeminal ganglion neurons as the substrate of
recurrent oral-facial HSV infection has been well-established. During the period of HSV latency, viral RNA
transcripts have been demonstrated in ganglion neurons by in
situ hybridization. With viral reactivation, viral antigens
and infectious virus are readily detected in ganglia.
However, evidence of neuronal latency or of viral
reactivation is not available for the geniculate ganglion in
patients with Bell's palsy. From the clinical vantage point,
the large study of Sullivan et al.,2 which showed
efficacy of steroid alone and no antiviral benefit, is
compelling. In addition, the fact that steroid alone did not
worsen putative viral infection suggests that viral
infection is probably not present. The emphasis on antiviral
use while likely not clinically harmful has probably slowed
investigations of the true cause of Bell's palsy. Evidence-based medicine does not support the use of antivirals in the
treatment of Bell's palsy.
Disclosures: R. Tenser has received honoraria from Biogen
Idec, Novartis, Pfizer/Serono, and Teva.
References
1. Halperin JJ. Bell's palsy treatment strategies:
antivirals may help some patients. Neurol Clin Pract
2012;2:245-247.
2. Sullivan FM, Swan IRC, Donnan PT, et al. Early treatment
with prednisone or acyclovir in Bell's palsy. N Engl J Med
2007;357:1598-1607.
Disclosures: R. Tenser has received honoraria from Biogen Idec, Novartis, Pfizer/Serono, and Teva.
References
1. Halperin JJ. Bell's palsy treatment strategies: antivirals may help some patients. Neurol Clin Pract 2012;2:245-247.
2. Sullivan FM, Swan IRC, Donnan PT, et al. Early treatment with prednisone or acyclovir in Bell's palsy. N Engl J Med 2007;357:1598-1607.