LETTER RE: Bell's palsy treatment strategies: Antivirals may help some patients

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.