The Analysis of Treatment with Acyclovir and Prognostic Factors on Idiopathic Facial Mononeuropathy Using Sunnybrook Scale.
- Author:
Ho Jung KIM
1
;
Byung Jo KIM
;
Seong Beom KOH
;
Kun Woo PARK
;
Dae Hie LEE
;
Seung Hwan LEE
Author Information
1. Department of Neurology, Korea University College of Medicine, Korea. nukbj@korea.ac.kr
- Publication Type:Original Article
- Keywords:
Idiopathic facial mononeuropathy;
Acyclovir;
Electrodiagnostic study;
Sunnybrook scale
- MeSH:
Action Potentials;
Acyclovir*;
Blinking;
Facial Nerve;
Herpesvirus 1, Human;
Humans;
Mononeuropathies*;
Paralysis
- From:Journal of the Korean Neurological Association
2007;25(4):455-461
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
BACKGROUND: Based on a recent study showing that the reactivation of HSV-1 may be one of the possible pathogenesis of idiopathic facial mononeuropathy, antiviral therapy has been suggested as a good treatment modality. However, the efficacy of antiviral therapy is still controversial. This argument may be caused by the absence of a reliable system of grading facial nerve paralysis. We performed this study to investigate the therapeutic effects of an antiviral agent and possible prognostic factors using the Sunnybrook scale. METHODS: Patients with idiopathic facial mononeuropathy were divided as two groups according to the treatment regimens (Acyclovir & Steroid vs. Steroid only). Clinical efficacy was evaluated using the House-Brackmann grading system and Sunnybrook scale. Electrodiagnostic studies including the blink reflex, facial nerve conduction study, and facial nerve excitability test were performed. The clinical improvement rate between the two groups and the usefulness of the electrodiagnostic studies as prognostic factors were analyzed. RESULTS: No significant differences of the clinical improvement rate was revealed with a 70% improvement rate for the Acyclovir treatment group and 84% for the steroid only group. Among electrodiagnostic studies, the compound muscle gamma action potential (CMAP) amplitude (=0.637, p=0.000) and nerve excitability =0.688, gamma test (p=0.000) on 2 weeks showed significant correlations to the final Sunnybrook score. There is good correlation between the two facial nerve grading systems. CONCLUSIONS: Acyclovir may not be effective in the recovery of idiopathic facial mononeuropathy. CMAP amplitude and nerve excitability tests on 2 weeks may provide valuable prognostic factors. The Sunnybrook scale may be useful as a facial grading system.
