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Original Investigation |

Role of Nitric Oxide in the Onset of Facial Nerve Palsy by HSV-1 Infection

Naohito Hato, MD1; Hisashi Kohno, MD1; Hiroyuki Yamada, MD1; Hirotaka Takahashi, MD1; Kiyofumi Gyo, MD1
[+] Author Affiliations
1Department of Otolaryngology, Ehime University School of Medicine, Shitsukawa Toon-city, Ehime, Japan
JAMA Otolaryngol Head Neck Surg. 2013;139(12):1339-1342. doi:10.1001/jamaoto.2013.5542.
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Importance  Although herpes simplex virus type 1 (HSV-1) is a causative agent of Bell palsy, the precise mechanism of the paralysis remains unknown. It is necessary to investigate the pathogenesis and treatment of Bell palsy due to HSV-1 infection.

Objective  This study elucidated the role of nitric oxide (NO) in the incidence of facial nerve paralysis caused by HSV-1 in mice and to evaluate the possible role of edaravone, a free radical scavenger, in preventing the paralysis.

Design, Setting, Participants  Sixty-two mice served as animal models of Bell palsy in this laboratory study conducted at an academic institution.

Interventions  Levels of NO in the facial nerve were measured using high-performance liquid chromatography and absorption photometry. The incidence of facial palsy was assessed following administration of edaravone immediately after HSV-1 inoculation and daily for 11 days thereafter.

Main Outcomes and Measures  The ratio of NO (inoculated side to control side) and incidence of facial palsy.

Results  Before the onset of facial palsy, no substantial difference in the NO level was noted between the HSV-1–inoculated side and the control side. When facial palsy occurred, usually at 7 days after inoculation, the NO level was significantly higher on the inoculated side than on the control side. Following recovery from the palsy, the high NO level of the inoculated side decreased. No increase in the NO level was observed in animals without transient facial palsy. When edaravone was administered, the incidence of facial palsy decreased significantly.

Conclusions and Relevance  These findings suggest that NO produced by inducible NO synthase in the facial nerve plays an important role in the onset of facial palsy caused by HSV-1 infection, which is considered a causative virus of Bell palsy.

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Figure.
Measurements of Nitrite (NO2) and Nitrate (NO3) Levels by Absorption Photometry

The NO2 and NO3 levels were measured in the bilateral facial nerves of a paralyzed mouse on day 7 after inoculation with herpes simplex virus type 1 (HSV-1) (group C).

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