Viral infection and acute peripheral facial palsy. A study with herpes simplex and varicella zoster viruses

The role of herpes simplex virus (HSV) and varicella zoster virus (VZV) in acute peripheral facial palsy (APFP) was evaluated according to clinical symptomatology and serologic findings in a series of 70 patients seen over a one-year period. Peak morbidity of APFP occurred in the 21 to 30 years age group. Most patients were under 40 years of age and there were more female than male patients. Concomitant dysfunction of one or more other cranial nerves was present in most patients. The sera of patients were examined for IgG antibodies to HSV and VZV by the indirect immunoperoxidase technique. The geometric mean titer for VZV antibodies was significantly higher in the VZV-seropositive APFP patients than in the seropositive matched healthy control subjects. Nine APFP patients had increased or fourfold-rising VZV antibody titers on subsequent examinations, although six of them had presented without any evidence of zosterian eruption. The proportion of APFP patients with HSV antibodies at the time of admission was significantly higher than that of matched control subjects. No significant difference was found in the geometric mean titer for HSV antibodies between seropositive APFP patients and the seropositive control subjects. Only one patient in the series showed a fourfold rise in HSV antibodies, although the clinical symptomatology was compatible with this infection in 17 patients. The significance of serologic studies in determining the etiology of APFP is discussed.