A reader expressed confusion regarding why a patient diagnosed with Bell’s palsy would be given acyclovir (Item 101-15). Bell’s palsy is believed to be caused by a virus; several studies indicate a link to the herpes simplex virus. All patients diagnosed with this condition should be started on a steroid and an antiviral. Valacyclovir is my first choice.
—Kimberly Brown, MMS, PA-C, St. Louis

This is an excellent point. Some data show a link between the herpesvirus and many cases of Bell’s palsy. And at least one randomized, controlled trial showed a benefit from the combination of acyclovir and prednisone vs. prednisone alone. The improved outcomes were mostly in terms of facial function (Ann Otol Rhinol Laryngol. 1996;105:371-378). However, other studies have not supported these findings conclusively. Therefore, while many would consider prednisone and acyclovir as “first-line” treatment early (one week or less) in the course of Bell’s palsy, the American Academy of Neurology states that the benefit is not definitively established (Neurology. 2001;56:830-836).
—Christopher Ruser, MD (107-16)

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