Early Treatment of Herpes Zoster Stops Its Facial Palsy
November 1, 2000 2 minutes read
Early Treatment of Herpes Zoster Stops Its Facial Palsy
Abstract & commentary
Source: Furuta Y, et al. Early diagnosis of zoster sine herpete and antiviral therapy for the treatment of facial palsy. Neurology 2000;55:708-710.
Furuta and colleagues treated 163 patients older than 10 years of age with acute peripheral facial palsy (APFP), all at first called Bell’s palsy, and within five days of onset.
All patients had saliva tested by polymerase chain reaction (PCR) for possible H. zoster, 82 of whom obtained results within two days. Additionaly, saliva samples were collected on all patients at 4-12 visits and had Eliza kit analysis testing for anti-varicella zoster virus (VSV) antibodies. All patients were evaluated within five days of facial weakness and those with facial palsy grade V and VI received 60 mg prednisone for four days, then tapered off. Patients positive for VZV DNA (18 = 21% of 86) were treated with acyclovir-prednisone (a-p). Two developed zoster lesions within two days of the palsy and 13 more received a-p within seven days of onset. Three other patients received a-p eight days or later after onset. All 13 a-p patients who were treated with the drugs on or before day 8 recovered completely by three months. In contrast, the remaining 20 who received steroids alone recovered only 65% of normal facial movements by six months.
Commentary
Furuta et al indicated that the time and labor required to identify the zoster testing of these patients within 2-3 days of diagnosis would limit this protocol for general use. However, many hospitals and clinical laboratories now have instruments to process PCR promptly and are only moderately expensive. On the other hand, the PDR description of undesirable reactions to acyclovir are few. Mild nausea, mild confusion among the elderly, and no adversity to breast feeding are noted. Given the distress of prolonged facial palsy and possible zoster pain, Neurology Alert urges treatment with prednisone 60 mg per day and acyclovir of "Bell’s Palsy" within six days of onset. —Fred Plum
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