From the Guidelines
Epstein-Barr virus (EBV) can rarely cause paralysis through several mechanisms, including triggering Guillain-Barré syndrome, an autoimmune disorder where the immune system attacks peripheral nerves, leading to ascending paralysis, as reported in studies such as 1.
Mechanisms of EBV-Related Paralysis
- EBV infection may trigger Guillain-Barré syndrome, an autoimmune disorder where the immune system attacks peripheral nerves, leading to ascending paralysis.
- EBV can also cause facial paralysis (Bell's palsy) or, in severe cases, encephalitis or myelitis affecting the brain or spinal cord, resulting in various forms of paralysis, as seen in cases with chronic active EBV infection syndrome (SCAEBV) 1.
Treatment and Management
- Treatment typically involves supportive care while the immune system fights the virus.
- For Guillain-Barré syndrome, intravenous immunoglobulin (IVIG) at 0.4 g/kg daily for 5 days or plasma exchange may be used.
- Corticosteroids like prednisone (60-80 mg daily, tapered over 1-2 weeks) might help with facial paralysis.
- Antiviral medications aren't typically effective against EBV-related neurological complications, as noted in the proposed guidelines for diagnosing chronic active EBV infection 1.
Prognosis and Recovery
- Most patients recover completely with proper supportive care, though recovery can take weeks to months.
- The connection between EBV and paralysis stems from the virus's ability to trigger inappropriate immune responses that damage nerve tissue rather than direct viral invasion of nerves, highlighting the importance of early diagnosis and treatment to prevent long-term neurological damage 1.
From the Research
EBV and Paralysis
- Epstein-Barr virus (EBV) infection can lead to various neurological complications, including paralysis, in rare cases 2, 3, 4.
- A study published in 2012 reported a case of a 19-year-old woman with EBV encephalitis who developed raised intracranial pressure and required decompressive craniectomy, but eventually made a good recovery after treatment with corticosteroids and aciclovir 2.
- Another study published in 2010 reviewed the use of antivirals in the management of severe EBV infections, including those with CNS involvement, and found that 39 out of 45 patients had a favorable outcome after receiving antiviral treatment, including acyclovir monotherapy 3.
- A study published in 2011 investigated the viral loads and clinical characteristics of primary EBV infection with neurological complications and found that 9 patients had a primary EBV infection with neurological symptoms, including meningeal signs, epileptic insults, and polyradiculomyelitis 4.
- There is limited evidence on the effectiveness of antiviral drugs in treating EBV-related paralysis, and more research is needed to determine the best course of treatment 5, 6.
Treatment Options
- Antiviral drugs, such as acyclovir and valacyclovir, have been used to treat EBV infections, but their effectiveness in treating EBV-related paralysis is unclear 3, 5, 6.
- Corticosteroids have been used to treat EBV encephalitis and other neurological complications, but their use in treating EBV-related paralysis is not well established 2, 3.
- Decompressive craniectomy has been used in some cases of EBV encephalitis with raised intracranial pressure, but its use in treating EBV-related paralysis is not well established 2.