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