Reactivation of herpes simplex virus type 1 and varicella-zoster virus and therapeutic effects of combination therapy with prednisolone and valacyclovir in patients with Bell's palsy

Laryngoscope. 2007 Jan;117(1):147-56. doi: 10.1097/01.mlg.0000248737.65607.9e.


Objectives: To determine whether reactivation of herpes simplex virus (HSV) type 1 or varicella-zoster virus (VZV) is the main cause of Bell's palsy and whether antiviral drugs bring about recovery from Bell's palsy.

Study design: Randomized, multicenter, controlled study.

Methods: One hundred fifty patients with Bell's palsy were enrolled in this study. The patients were randomly assigned to a prednisolone group or a prednisolone-valacyclovir group, in whom virologic examinations for HSV-1 and VZV were performed by simple randomization scheme in sealed envelopes. The recovery rates among various groups were analyzed using the Kaplan-Meier method and the Cox proportional hazards model.

Results: Reactivation of HSV-1, VZV, and both viruses was detected in 15.3%, 14.7%, and 4.0% of patients, respectively. There was no significant difference in recovery rates between the prednisolone group and the prednisolone-valacyclovir group, although recovery in the patients with HSV-1 reactivation tended to be higher in the prednisolone-valacyclovir group than in the prednisolone group. There was a significant difference in recovery among age groups and between individuals with complete and incomplete paralysis.

Conclusions: Reactivation of HSV-1 or VZV was observed in 34% of the patients with Bell's palsy. The effect of combination therapy with prednisolone and valacyclovir on recovery was not significantly higher than that with prednisolone alone.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acyclovir / analogs & derivatives*
  • Acyclovir / therapeutic use
  • Adult
  • Aged
  • Anti-Inflammatory Agents / therapeutic use*
  • Antibodies / blood
  • Antiviral Agents / therapeutic use*
  • Bell Palsy / drug therapy*
  • Bell Palsy / etiology
  • Bell Palsy / immunology
  • Bell Palsy / virology
  • Drug Therapy, Combination
  • Female
  • Herpesvirus 1, Human / immunology
  • Herpesvirus 1, Human / physiology*
  • Herpesvirus 3, Human / immunology
  • Herpesvirus 3, Human / physiology*
  • Humans
  • Kaplan-Meier Estimate
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Prednisolone / therapeutic use*
  • Proportional Hazards Models
  • Treatment Outcome
  • Valacyclovir
  • Valine / analogs & derivatives*
  • Valine / therapeutic use
  • Virus Activation / physiology


  • Anti-Inflammatory Agents
  • Antibodies
  • Antiviral Agents
  • Prednisolone
  • Valine
  • Valacyclovir
  • Acyclovir