Efficacy of Early Treatment of Bell’s Palsy With Oral Acyclovir and Prednisolone Otology & Neurotology 24: , 2003, Nov Naohito 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

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