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Antiviral Won't Improve Bell's Palsy Outcome
Date:10/17/2007

Cheap, standard treatment best against the facial paralysis, study finds

WEDNESDAY, Oct. 17 (HealthDay News) -- The antiviral drug acyclovir is no better at easing a form of facial paralysis called Bell's palsy than traditional treatment, a new study finds.

The fact that acyclovir may not be a new, improved treatment option comes as bad news for patients, experts say, but on the other hand, many people afflicted with Bell's palsy do get better with the current regimen.

The study results suggest that these patients may not need to spend money on a second drug that's hardly cheap, noted Dr. Donald Gilden, chairman of the University of Colorado's department of neurology, in Denver.

The study "will likely change practice" by convincing doctors to avoid acyclovir when treating Bell's palsy, said Gilden, who co-authored a commentary accompanying the study findings, published in the Oct. 18 issue of the New England Journal of Medicine.

Bell's palsy strikes up to 40 of every 100,000 people each year, often between ages 30 and 45. An estimated one in 60 people will be affected by the facial paralysis during their lifetime.

Patients typically have trouble moving some parts of their face, which can droop. "It paralyzes the muscles of facial expression affecting the muscles around the eye, so that the eyelids cannot be closed properly, and around the mouth so that smiling, speech and mouth closure are affected," explained study lead author Frank Sullivan, a researcher at the Scottish School of Primary Care in Dundee, Scotland.

The cause is unknown, although there's some suspicion that Bell's palsy may be connected to a viral infection caused by the same strain of herpes that causes cold sores. This infection can recur as shingles long after a chickenpox infection, Sullivan added.

Typically, Bell's palsy clears up on its own over time or after patients are treated with prednisolone, a steroid related to the more commonly known prednisone. Prednisolone stops the immune system from creating so much inflammation.

Still, some patients with Bell's palsy experience permanent facial disfigurement.

In the new study, the Scottish team looked at 496 Bell's palsy patients who were randomly assigned to receive 10 days of one of four treatment regimens: prednisolone; acyclovir; both drugs in combination; or a placebo.

Acyclovir (brand name Zovimax) is widely used to treat genital herpes. According to Gilden, a course of prednisolone costs about $10, compared to $200 for the antiviral drug.

After nine months, 94 percent of those who took prednisolone had recovered, compared to 85 percent of those who took acyclovir. Ninety-three percent of those who took both drugs got better.

Typically, 75 percent to 80 percent of those who take no drugs get better, lead author Sullivan said.

In essence, the study looks at whether patients with Bell's palsy should take antivirals in addition to the steroid, and the answer is that "you probably don't," Gilden said.

More information

Learn more about Bell's palsy from the U.S. National Institute of Neurological Disorders and Stroke.



SOURCES: Donald Gilden, M.D., chairman, University of Colorado, Denver; Frank Sullivan, Ph.D., researcher, Scottish School of Primary Care, Dundee, U.K.; Oct. 18, 2007, New England Journal of Medicine


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