Efficacy of Early Treatment of Bell’s Palsy With Oral Acyclovir and Prednisolone

Otology & Neurotology

24:948-951, 2003, NovNaohito Hato, Shuichi Matsumoto, Hisanobu Kisaki, etc

To investigate the therapeutic effects of acyclovir and prednisolone in relation to the timing of treatment in Bell’s palsy.

Bell’s Palsy Idiopathic Peripheral facial palsy Sudden onset

HSV Reactivation VZV Reactivation

Bell’s Palsy > 10 % patients are unable to

recover normal facial movement after conventional treatment

Acyclovir therapy has been evaluated in some trials

Correlation between the timing of treatment and the recovery function

Patients

Oct 1986 ~ Dec 2000 Bell’s palsy: without CNS disorders,

neoplasms, otits media, trauma or herpes zoster oticus

1023 patients

Patient selection Severe, with Yanagihara score < 20 Begin treatment within 7 days, no initial Tx > 6 months F/U, or complete recovery No systemic disease, no contraindication of

steroid use Only medication, no surgical intervention

Yanagihara score

Drug Dosage

Adult: Acyclovir 2000mg/d x 7days

Prednisolone 1 mg/kg per day Pediatric patients:

Acyclovir 80mg/kg per day x 5days

Prednisolone 1 mg/kg per day

Table1

Table2

Table3

Table4

Acyclovir is less effective later after onset Acyclovir affects only replicating viruses Acyclovir is unable to destroy viruses that h

ave already relpicated

Conclusion

Early diagnosis and treatment within 3 days of the onset of paralysis are necessary for maximal efficacy of combined acyclovir and prednisolone therapy for Bell's palsy.