Treatment and Prognosis of Facial Palsy on Ramsay Hunt Syndrome: Results Based on a Review of the Literature

Monsanto, Rafael da Costa; Bittencourt, Aline Gomes; Bobato Neto, Natal José; Beilke, Silvia Carolina Almeida; Lorenzetti, Fabio Tadeu Moura; Salomone, Raquel

doi:10.1055/s-0036-1584267

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Systematic Review • Int. Arch. Otorhinolaryngol. 20 (04) • Oct-Dec 2016 • https://doi.org/10.1055/s-0036-1584267 linkcopy

Treatment and Prognosis of Facial Palsy on Ramsay Hunt Syndrome: Results Based on a Review of the Literature

Authorship SCIMAGO INSTITUTIONS RANKINGS

Introduction Ramsay Hunt syndrome is the second most common cause of facial palsy. Early and correct treatment should be performed to avoid complications, such as permanent facial nerve dysfunction.

Objective The objective of this study is to review the prognosis of the facial palsy on Ramsay Hunt syndrome, considering the different treatments proposed in the literature.

Data Synthesis We read the abstract of 78 studies; we selected 31 studies and read them in full. We selected 19 studies for appraisal. Among the 882 selected patients, 621 (70.4%) achieved a House-Brackmann score of I or II; 68% of the patients treated only with steroids achieved HB I or II, versus 70.5% when treated with steroids plus antiviral agents. Among patients with complete facial palsy (grades V or VI), 51.4% recovered to grades I or II. The rate of complete recovery varied considering the steroid associated with acyclovir: 81.3% for methylprednisolone, 69.2% for prednisone; 61.4% for prednisolone; and 76.3% for hydrocortisone.

Conclusions Patients with Ramsay-hunt syndrome, when early diagnosed and treated, achieve high rates of complete recovery. The association of steroids and acyclovir is better than steroids used in monotherapy.

Keywords:
prognosis; facial palsy; ramsay hunt syndrome; varicela zoster; house-brackmann

Authors	No. of patients	HB scale and patients		Treatment	Follow-up	Patients with HB I or II AT
Authors	No. of patients	BT	AT	Treatment	Follow-up	Patients with HB I or II AT
Ryu et al¹⁶	155	HB III – 24	HB I or II – 22	Prednisolone (80 mg oral methylprednisolone per day for 4 days, 60 mg/d for 2 days, 40 mg/d for 2 days, 20 mg/d for 2 days, and 10 mg/d for 5 days);Acyclovir (4000 mg/d for 7 days)	3 months	91 (58.7%)
		HB IV – 53	HB I or II – 35
		HB V or VI – 78	HB I or II – 34
Zainine et al⁴	15	HB III – 1	HB I – 1	Hydrocortisone (100 mg 3x/day IV for 8 days)Acyclovir (4000 mg/d PO for 8 days)	8 months	10 (66.6%)
		HB IV – 8	HB I – 4HB II – 2HB III – 1HB IV – 1
		HB V – 6	HB II – 3HB V – 3
Kansu et al¹²	01	HB V – 1	HB IV – 1	Corticosteroid (1 mg/kg/d)Acyclovir (90 mg/kg/d)	4 months	00 (0%)
Donati et al²	01	HB V – 1	HB I – 1	Oral valacyclovir (3 g/day, lowered to 1.5 g/day after1 week) and prednisone 50 mg/day.On day 66–methylprednisolone (1 g/day I.V. for 5 days.	248 days	02 (100%)
Donati et al²	01	HB V – 1	HB I – 1	Oral acyclovir (800 mg/day) for10 days and prednisone 75 mg/d.On day 37–methylprednisolone, 1 g/day I.V. for 3 days	73 days	–
Shim et al¹⁷	339	HB II – 40	HB I – 33HB II – 7	Prednisone (1 mg/kg/d orally for 4 days, tapered to zero until day 10)Acyclovir (400 mg/8h for 5 days)	6 months	225 (66.3%)
		HB III – 95	HB I – 52HB II – 34HB III – 9
		HB IV – 137	HB I – 30HB II – 52HB III – 26HB IV – 29
		HB V – 67	HB I- 12HB II – 5HB III – 21HB IV – 13HB V – 16
Kim et al¹³	11	HB II – 5	HB I – 5	Steroids (40 to 60 mg of prednisolone, or 48 mg of methylprednisolone, orally, for 10 to 37 daysAcyclovir (750 to 4800 mg, intravenously, for 5 to 12 days)	6 months	09 (81.8%)
		HB III – 1	HB II – 1
		HB IV – 2	HB II – 2
		HB V – 3	HB II – 1HB III – 2
Boemo et al¹	54	HB II – 4	HB I – 4	Acyclovir 250 mg/8h and methylprednisolone 120 mg/d IV for 48h; then acyclovir 850 mg/8h for 10 days and methylprednisolone 30mg/d orally, in a decreasing dosage for 16 days	6 months	33 (61.1%)
		HB III – 8	HB I – 8
		HB IV – 20	HB I – 10HB III – 8HB IV – 2
		HB V – 22	HB I – 3HB II – 8HB III – 6HB IV – 5
Gondivkar et al⁸	01	HB V – 1	HB I – 1	Initial dose of acyclovir and steroids I.V., and a 2-week course of oral acyclovir and steroids after discharge;Transcutaneal electrical nerve stimulation and facial neuromuscular exercise.	5 weeks	01 (100%)
Yeo et al⁶	26	HB II – 3	HB I – 2HB II – 1	Prednisolone (1 mg/kg/d IV for 5 days; then, the dose was tapered for another 5 days);Acyclovir (5 mg/kg/8h IV for 5 days);Famciclovir (500 mg orally for 7 days, after the 5-day cycle of acyclovir);Dextran;Peripheral vasodilators.	6 months	22 (84.6%)
		HB III – 13	HB I – 7HB II – 4HB III – 2
		HB IV – 10	HB I – 4HB II – 4HB III – 1HB IV – 1
Furuta et al⁷	37	HB II – 1	HB I – 1	Acyclovir (4000 mg in tablet form or 750 mg per day by infusion) or valacyclovir (3000 mg in tablets) was administered to all patients for 5 to 7 days.Patients with grade IV to VI facial paralysis were usually given 40 to 60 mg prednisone for 4 days.	6 months	27 (72.9%)
		HB III – 3	HB I – 3
		HB IV – 9	HB I – 9
		HB V – 17	HB I – 9HB II – 2HB III – 5HB IV – 1
		HB VI – 7	HB I – 2HB II – 1HB III – 1HB IV – 3
Uri et al¹¹	23	HB IV – 3	HB I – 2HB III – 1	Acyclovir (5 mg/kg/8h intravenously for 7 days)Hydrocortisone (100 mg/8h intravenously for 7 days)	1 year	19 (82.6%)
		HB V – 2	HB I – 2
		HB VI – 18	HB I – 11HB II – 4HB III – 1HB IV – 1HB V – 1
Kinishi et al¹⁴	91	HB III – 2	HB I – 82	Dextran (500 mL, for 7 days)Methylprednisolone (500 m on day 1, 250 mg on days 2 and 3 and 100 mg for 4 days thereafterAdenosine triphosphate (ATP) and vitamins B6 and B12Acyclovir, 4000 mg/d, 7 days	6 months	85 (93.4%)
		HB IV – 17	HB II – 3
		HB V – 33	HB III – 5
		HB VI – 39	HB IV – 1
	47	HB III – 2	HB I – 30	The same protocol described above, but without the acyclovir		32 (68%)
		HB IV – 9	HB II – 2
		HB V – 17	HB III – 10
		HB VI – 19	HB IV – 5
Murakami et al¹⁵	80	HB III – 1	HB I – 1	Prednisone (1 mg/kg/d, orally or intravenously for 5 days; then, tapered to zero over the following 10 days);Acyclovir (250 mg/8h for 7 days intravenously or 800 mg 5 times/d orally, for 7 days)	1 year	65 (81.25%)
		HB IV – 21	HB I – 17HB II – 2HB III – 2
		HB V – 38	HB I – 20HB II – 12HB III – 5HB IV – 1
		HB VI – 20	HB I – 4HB II – 9HB III – 7
Total	882	–	–	–	–	621 (70.4%)

	No. of patients that achieved good prognosis with Prednisone	No. of patients that achieved good prognosis with Prednisolone	No. of patients that achieved good prognosis with Hydrocortisone	No. of patients that achieved good prognosis with Methylprednisolone
Ryu et al¹⁶	–	91/155	–	–
Zainine et al⁴	–	–	10/15	–
Shim et al¹⁷	225/339	–	–	–
Boemo et al¹	–	–	–	33/54
Furuta et al⁷	–	27/37	–	–
Uri et al¹¹	–	–	19/23	–
Kinishi et al¹⁴	–	–	–	85/91
Murakami et al¹⁵	65/80	–	–	–
Total	290/419 (69.2%)	118/192 (61.4%)	29/38 (76.3%)	118/145 (81.3%)

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[TFN1] Abbreviation: AT, after treatment; BT, before treatment; HB, graduation on the House-Brackmann facial palsy scale.