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August 11, 1975, Vol 233, No. 6 >
ARTICLE | August 11, 1975

Herpes Simplex Virus in Idiopathic Facial Paralysis (Bell Palsy) FREE

Kedar Karim Adour, MD; Douglas N. Bell, MD; Raymond L. Hilsinger, Jr., MD
[+] Author Affiliations

Reprint requests to Facial Paralysis Research Clinic, Department of Otolaryngology, Kaiser-Permanente Medical Center, 280 W MacArthur Blvd, Oakland, CA 94611 (Dr. Adour).


JAMA. 1975;233(6):527-530. doi:10.1001/jama.1975.03260060037015
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References

Sera from all 41 adult patients with idiopathic facial paralysis (Bell palsy) and 35 (85%) of 41 matched controls who had never had Bell palsy contained antibodies to herpes simplex virus (P <.05). The frequency of antibodies to herpes zoster virus did not differ in patients and controls. A rise in antibody titer, indicating primary herpes simplex virus infection, was not found in these patients.

That Bell palsy may be caused by reactivation of herpes simplex virus is suggested by (1) clinical, neurologic, laboratory, and immunologic similarities between idiopathic facial paralysis and known manifestations of reactivated herpes simplex virus infection, and (2) the known neurotropism of herpes simplex virus, including its presence in latent form in the trigeminal ganglia, and parallels with known facial paralysis due to varicella zoster virus, a closely related agent. The presence of antibodies to herpes simplex virus is the only common factor among the patients tested in this study. (JAMA 233:527-530, 1975)

REFERENCES

1 +
 Aetiology of Bell's palsy , editorial. Br Med J 4:2-3, 1971;.
2 +
Saunders WH, Lippy WH:  Sudden deafness and Bell's palsy: A common cause . Ann Otol Rhinol Laryngol 86:830-837, 1959;.
3 +
Fowler EP Jr:  The pathologic findings in a case of facial paralysis . Trans Am Acad Ophthalmol Otolaryngol 67:187-197, 1963;.
4 +
McCormick DP:  Herpes-simplex virus as cause of Bell's palsy . Lancet 1:937-939, 1972;.
5 +
Tomita H, Hayakawa W, Hondo R:  Varicella-zoster virus in idiopathic facial palsy . Arch Otolaryngol 95:364-368, 1972;.
6 +
Peitersen E, Caunt AE:  The incidence of herpes zoster antibodies in patients with peripheral facial palsy . J Laryngol Otol 84:65-70, 1970;.
7 +
Rowland LP:  Treatment of Bell's palsy . N Engl J Med 287:1298-1299, 1972;.
8 +
Adour KK, Swanson PJ Jr:  Facial paralysis in 403 consecutive patients: Emphasis on treatment response in patients with Bell's palsy . Trans Am Acad Ophthalmol Otolaryngol 75:1284-1301, 1971;.
9 +
Manning JJ, Adour KK:  Facial paralysis in children . Pediatrics 49:102-109, 1972;.
10 +
McNair Scott TF, Tokumaru T:  The herpesvirus group , in Horsfall FL Jr, Tamm I (eds): Rickettsial Infections of Man , ed 4. Philadelphia, JB Lippincott Co, 1965;, pp 892-903.
11 +
Leider W, Magoffin RL, Lennette EH, et al:  Herpes simplex virus encephalitis: Its possible association with reactivated latent infection . N Engl J Med 273:341-347, 1965;.
12 +
Nahmias AJ, Roizman B:  Infection with herpes-simplex viruses 1 and 2 . N Engl J Med 289:781-789, 1973;.
13 +
Douglas RG, Couch RB:  A prospective study of chronic herpes simplex virus infection and recurrent herpes labialis in humans . J Immunol 104:289-295, 1970;.
14 +
Adour KK, Doty HE:  Electronystagmographic comparison of acute idiopathic and herpes zoster facial paralysis . Laryngoscope 83:2029-2034, 1973;.
15 +
Safman BL:  Bilateral pathology in Bell's palsy . Arch Otolaryngol 93:55-57, 1971;.
16 +
Chaco J:  Subclinical peripheral nerve involvement in unilateral Bell's palsy . Am J Phys Med 52:195-197, 1973;.
17 +
Hopf HC:  Electromyographic study on socalled mononeuritis . Arch Neurol 9:307-312, 1963;.
18 +
Weller TH:  Varicella-herpes zoster virus , in Horsfall FL Jr, Tamm I (eds): Viral and Rickettsial Infections of Man , ed 4. Philadelphia, JB Lippincott Co, 1965;, pp 915-925.
19 +
Lewis GW:  Zoster sine herpete . Br Med J 2:418-421, 1958;.
20 +
Dalton GA:  Bell's palsy: Some problems of prognosis and treatment . Br Med J 2:1765-1770, 1960;.
21 +
Baringer JR, Swoveland P:  Recovery of herpes-simplex virus from human trigeminal ganglions . N Engl J Med 288:648-650, 1973;.
22 +
Bastian FO, Rabson AS, Yee CL, et al:  Herpesvirus hominis: Isolation from human trigeminal ganglion . Science 178:306-307, 1972;.
23 +
McGovern FH:  Trigeminal sensory neuropathy and Bell's palsy . Arch Otolaryngol 94:466-470, 1971;.
24 +
Ch'ien LT, Halsey JH Jr:  Trigeminal sensory neuropathy and Bell's palsy . N Engl J Med 282:224-225, 1970;.
25 +
Korczyn AD:  Sensory deficit in Bell's palsy . N Engl J Med 282:1493-1494, 1970;.
26 +
Jongkees LBW, Buchthal F, Cawthorne T, et al:  Round table discussion: Surgery versus conservative treatment in peripheral facial palsies . Arch Otolaryngol 81:536-546, 1965;.
27 +
Smith IW, Peutherer JF, MacCallum FO:  The incidence of Herpesvirus hominis antibody in the population . J Hyg 65:395-408, 1967;.
28 +
El-Ebiary HM:  Facial paralysis: A clinical study of 580 cases . Rheumatol Phys Med 11:100-110, 1971;.
29 +
Hauser WA, Karnes WE, Annis J, et al:  Incidence and prognosis of Bell's palsy in the population of Rochester, Minnesota . Mayo Clin Proc 46:258-264, 1971;.
30 +
Adour KK, Bell DN, Wingerd J: Bell palsy:  Dilemma of diabetes mellitus . Arch Otolaryngol 99:114-117, 1974;.
31 +
Nahmias AJ, Josey WE, Naib ZM:  Significance of herpes simplex virus infection during pregnancy . Clin Obstet Gynecol 15:929-938, 1972;.
32 +
Hilsinger RL Jr:  Bell's palsy in pregnancy , in Collected Letters of the International Correspondence Society of Ophthalmologists and Otolaryngologists, New Orleans, La . Series 19, (March 30) , 1974;, pp 41-42.
33 +
Alford BR:  Electrodiagnostic studies in facial paralysis . Arch Otolaryngol 85:259-264, 1967;.
34 +
Taverner D:  Bell's palsy: A clinical and electromyographic study . Brain 78:209-228, 1955;.
35 +
Stien R, Tonning FM:  Acute peripheral facial palsy . Arch Otolaryngol 98:187-190, 1973;.
36 +
Hennebert PE:  Traitement précoce de la paralysie faciale dite "à frigore" par des chélateurs . Acta Otorhinolaryngol Belg 27:75-78, 1973;.
37 +
Weiner LP, Johnson RT, Herndon RM:  Viral infections and demyelinating diseases . N Engl J Med 288:1103-1110, 1973;.
38 +
Cook ML, Bastone VB, Stevens JG:  Evidence that neurons harbor latent herpes simplex virus . Infect Immun 9:946-951, 1974;.
39 +
Baringer JR, Swoveland P:  Persistent herpes simplex virus infection in rabbit trigeminal ganglia , abstracted. Virol Abstr 7:65, 1974;.
40 +
McGovern FH, Edgemon LJ, Konigsmark BW:  Experimental ischemic facial paralysis . Arch Otolaryngol 95:331-334, 1972;.
41 +
Coassolo M:  Ricerche sperimentali sulla paralisi a frigore del facciale . Minerva Otorinolaringol 2:444-449, 1952;.
42 +
Baumel JJ:  Trigeminal-facial nerve communications: Their function in facial muscle innervation and reinnervation . Arch Otolaryngol 99:34-44, 1974;.
43 +
Wildy P:  The progression of herpes simplex virus to the central nervous system of the mouse . J Hyg 65:173-192, 1967;.
44 +
Thomas PK, Lascelles RG:  The pathology of diabetic neuropathy . Q J Med 35:489-509, 1966;.

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1 +
 Aetiology of Bell's palsy , editorial. Br Med J 4:2-3, 1971;.
2 +
Saunders WH, Lippy WH:  Sudden deafness and Bell's palsy: A common cause . Ann Otol Rhinol Laryngol 86:830-837, 1959;.
3 +
Fowler EP Jr:  The pathologic findings in a case of facial paralysis . Trans Am Acad Ophthalmol Otolaryngol 67:187-197, 1963;.
4 +
McCormick DP:  Herpes-simplex virus as cause of Bell's palsy . Lancet 1:937-939, 1972;.
5 +
Tomita H, Hayakawa W, Hondo R:  Varicella-zoster virus in idiopathic facial palsy . Arch Otolaryngol 95:364-368, 1972;.
6 +
Peitersen E, Caunt AE:  The incidence of herpes zoster antibodies in patients with peripheral facial palsy . J Laryngol Otol 84:65-70, 1970;.
7 +
Rowland LP:  Treatment of Bell's palsy . N Engl J Med 287:1298-1299, 1972;.
8 +
Adour KK, Swanson PJ Jr:  Facial paralysis in 403 consecutive patients: Emphasis on treatment response in patients with Bell's palsy . Trans Am Acad Ophthalmol Otolaryngol 75:1284-1301, 1971;.
9 +
Manning JJ, Adour KK:  Facial paralysis in children . Pediatrics 49:102-109, 1972;.
10 +
McNair Scott TF, Tokumaru T:  The herpesvirus group , in Horsfall FL Jr, Tamm I (eds): Rickettsial Infections of Man , ed 4. Philadelphia, JB Lippincott Co, 1965;, pp 892-903.
11 +
Leider W, Magoffin RL, Lennette EH, et al:  Herpes simplex virus encephalitis: Its possible association with reactivated latent infection . N Engl J Med 273:341-347, 1965;.
12 +
Nahmias AJ, Roizman B:  Infection with herpes-simplex viruses 1 and 2 . N Engl J Med 289:781-789, 1973;.
13 +
Douglas RG, Couch RB:  A prospective study of chronic herpes simplex virus infection and recurrent herpes labialis in humans . J Immunol 104:289-295, 1970;.
14 +
Adour KK, Doty HE:  Electronystagmographic comparison of acute idiopathic and herpes zoster facial paralysis . Laryngoscope 83:2029-2034, 1973;.
15 +
Safman BL:  Bilateral pathology in Bell's palsy . Arch Otolaryngol 93:55-57, 1971;.
16 +
Chaco J:  Subclinical peripheral nerve involvement in unilateral Bell's palsy . Am J Phys Med 52:195-197, 1973;.
17 +
Hopf HC:  Electromyographic study on socalled mononeuritis . Arch Neurol 9:307-312, 1963;.
18 +
Weller TH:  Varicella-herpes zoster virus , in Horsfall FL Jr, Tamm I (eds): Viral and Rickettsial Infections of Man , ed 4. Philadelphia, JB Lippincott Co, 1965;, pp 915-925.
19 +
Lewis GW:  Zoster sine herpete . Br Med J 2:418-421, 1958;.
20 +
Dalton GA:  Bell's palsy: Some problems of prognosis and treatment . Br Med J 2:1765-1770, 1960;.
21 +
Baringer JR, Swoveland P:  Recovery of herpes-simplex virus from human trigeminal ganglions . N Engl J Med 288:648-650, 1973;.
22 +
Bastian FO, Rabson AS, Yee CL, et al:  Herpesvirus hominis: Isolation from human trigeminal ganglion . Science 178:306-307, 1972;.
23 +
McGovern FH:  Trigeminal sensory neuropathy and Bell's palsy . Arch Otolaryngol 94:466-470, 1971;.
24 +
Ch'ien LT, Halsey JH Jr:  Trigeminal sensory neuropathy and Bell's palsy . N Engl J Med 282:224-225, 1970;.
25 +
Korczyn AD:  Sensory deficit in Bell's palsy . N Engl J Med 282:1493-1494, 1970;.
26 +
Jongkees LBW, Buchthal F, Cawthorne T, et al:  Round table discussion: Surgery versus conservative treatment in peripheral facial palsies . Arch Otolaryngol 81:536-546, 1965;.
27 +
Smith IW, Peutherer JF, MacCallum FO:  The incidence of Herpesvirus hominis antibody in the population . J Hyg 65:395-408, 1967;.
28 +
El-Ebiary HM:  Facial paralysis: A clinical study of 580 cases . Rheumatol Phys Med 11:100-110, 1971;.
29 +
Hauser WA, Karnes WE, Annis J, et al:  Incidence and prognosis of Bell's palsy in the population of Rochester, Minnesota . Mayo Clin Proc 46:258-264, 1971;.
30 +
Adour KK, Bell DN, Wingerd J: Bell palsy:  Dilemma of diabetes mellitus . Arch Otolaryngol 99:114-117, 1974;.
31 +
Nahmias AJ, Josey WE, Naib ZM:  Significance of herpes simplex virus infection during pregnancy . Clin Obstet Gynecol 15:929-938, 1972;.
32 +
Hilsinger RL Jr:  Bell's palsy in pregnancy , in Collected Letters of the International Correspondence Society of Ophthalmologists and Otolaryngologists, New Orleans, La . Series 19, (March 30) , 1974;, pp 41-42.
33 +
Alford BR:  Electrodiagnostic studies in facial paralysis . Arch Otolaryngol 85:259-264, 1967;.
34 +
Taverner D:  Bell's palsy: A clinical and electromyographic study . Brain 78:209-228, 1955;.
35 +
Stien R, Tonning FM:  Acute peripheral facial palsy . Arch Otolaryngol 98:187-190, 1973;.
36 +
Hennebert PE:  Traitement précoce de la paralysie faciale dite "à frigore" par des chélateurs . Acta Otorhinolaryngol Belg 27:75-78, 1973;.
37 +
Weiner LP, Johnson RT, Herndon RM:  Viral infections and demyelinating diseases . N Engl J Med 288:1103-1110, 1973;.
38 +
Cook ML, Bastone VB, Stevens JG:  Evidence that neurons harbor latent herpes simplex virus . Infect Immun 9:946-951, 1974;.
39 +
Baringer JR, Swoveland P:  Persistent herpes simplex virus infection in rabbit trigeminal ganglia , abstracted. Virol Abstr 7:65, 1974;.
40 +
McGovern FH, Edgemon LJ, Konigsmark BW:  Experimental ischemic facial paralysis . Arch Otolaryngol 95:331-334, 1972;.
41 +
Coassolo M:  Ricerche sperimentali sulla paralisi a frigore del facciale . Minerva Otorinolaringol 2:444-449, 1952;.
42 +
Baumel JJ:  Trigeminal-facial nerve communications: Their function in facial muscle innervation and reinnervation . Arch Otolaryngol 99:34-44, 1974;.
43 +
Wildy P:  The progression of herpes simplex virus to the central nervous system of the mouse . J Hyg 65:173-192, 1967;.
44 +
Thomas PK, Lascelles RG:  The pathology of diabetic neuropathy . Q J Med 35:489-509, 1966;.

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