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  1. #1
    Join Date
    Oct. 26, 2006
    Posts
    42

    Default EPM Advice Needed

    If you have had an experience with this disease with a horse you have owned or known, I would really like to hear your perspective.

    Also do you think that epm rare, or common and underdiagnosed? My vet seems to think its common, but I am leary of it being a catch-all diagnosis.

    What were the signs that tipped you off? Besides the standard "ataxia and atrophy," what were the milder signs that you saw? I have heard that some horses exhibit different signs such as crabbiness, poor performance, headshaking, roaring, lack of balance behind for the farrier, and cross cantering.

    I am confused about the field tests such as pulling their hindquarters off to the side by the tail or setting the hoof in an awkward spot. How can you tell if its a lack of proprioception or you just happen to have a very laidback horse?

    Has anyone seen the milder symptoms develop over a long period, like a year? Or is it always a sudden onset like a month or less?

    Finally, I have read on this forum about Diclazuril and the seven shot series. How do you get this stuff? My vet is not familiar with it.

    I am tagging this post with equine protozoan myelitis and Marquis so it will come up on future searches.



  2. #2
    Join Date
    Nov. 4, 2003
    Location
    Sanger, TX, USA
    Posts
    5,635

    Default

    Go to www.epm@yahoogroups.com. A message board for EPM horse owners,
    have been on it for years as Basque is a recovered EPM horse. The list owner
    also has a lot of reference material on her web site, www.meadowherbs.com.



  3. #3
    Join Date
    Nov. 8, 2006
    Posts
    2,984

    Default

    My horse presented slowly. Started with bilateral hind toe dragging, then muslce wasting, somewhere in there his auto changes became "can't change behind" and he would occasionally step down on his toe when walking up and down hills instead of placing the foot flat for a normal step. We estimate he was "infected" or first began symptoms 4-5 months earlier.

    On the clinic exam.. I'm think it's a tool but a very poor one. I asked the vet the same question after his nuero exam: what if he's just being lazy, because he's a laid back warmblood?

    For my horse it was complicated because his epm was also causing inflammation and small injuries in his hind legs that with hindsight were caused by the nuero deficit. We know it was from the epm, but without hindsight they seemed primary. Therefore we spent the time treating injuries and many of his symptoms were easily explained by that. Muscle wasting: he was in little to no work. Toe dragging: he's injured Tripping: he's dumb

    **Sigh**



  4. #4
    Join Date
    Nov. 8, 2006
    Posts
    2,984

    Default

    To answer you first question. Yes, I think epm is an overdiagnosed catch-all when the horse has deficits on the nuero exam and the vet can't figure out why... but that doesn't mean it's rare, because I don't think thats the case either. When I first moved to Texas, I had never heard of EPM because I came from a part of the country that doesn't have opposems and therefore the only cases of epm the vets see are horses shipped in from other areas that were dormant carriers that became active.

    For my horse, I was leary (very, very leary) of the diagnoses, so the vet recommended treating with navigator ($150/month). When we saw a noticeble improvement in gait and attitute in that time, then we had a definite dx. It took three years for him to return to his previous show condition in terms of both getting muscle, strength and coordination back. Our comeback was also stifled severely by the suspensory injury and a joint infection (lost 200 lbs- big set back). Coordination seems to be that last thing to come... but my measurement is rather unscientific: his flying changes (it was amazing, like a light bulb went on and he could suddenly do them both direction in and out of counter canter, where as the week before one direction was consitently several strides late) His ablility to legyield and halfpass were also directly related and these 3 movements all came back at the same time. It was very interesting (and sad) to see a highly trained show horse struggling to relearn things he could easily do as a 5 year old. The saving grace for this horse is his amazing work ethic and refusal to be retired both times we tried to make him a pasture ornament/ trail buddy.

    He signed up to debut as a hunter next month and will be showing in the rated 3'3" division. I'm very excited for him (and me). He is soo much happier now than he's been since his problems started.



  5. #5
    Join Date
    Jan. 16, 2007
    Posts
    2,169

    Default

    The clinical exam just shows neurological deficits, it doesn't tell you why they are there. Could be spinal compression (wobblers), EPM, or any of a number of other neurological issues.

    It also takes a very very good and experienced eye to see the subtle deficits. The scale is judged 1 to 5, a 1 being deficits which aren't readily apparent unless you do the tests, and a 5 being unable to stand.

    The tail pull is definitely subjective--sort of like flexions, depends on the person doing it. What is not subjective is "circumduction," where the horse is spun in a small circle and the outside hind leg swings out too far as he turns.

    This can be hard to see also. One neurological specialist told me that a vet should always stand back and watch while someone else spins the horse, because it's difficult to see if you are the handler.

    Another clue is how the horse puts down their feet, particularly when walked down a slope with their head raised. A neurological horse will "hover" the hooves, as if they don't quite know where the ground is. You kinda have to see this, it's hard to describe. But a normal horse places its feet on the ground with confidence, sort of like we walk normally, we just "know" where our feet will meet the ground and we just put them there, we don't feel for it.

    One more test that is fairly definitive is placing one front hoof across the other. Normal horses resist doing this, or if they do it, they will put their foot back within 30 seconds. This is a normal reflex action. A neurologic horse just stands there, not realizing where his feet are.

    ******

    As to other clues, dragging toes, knuckling the hind hooves frequently, stumbling, especially in downward transitions, "plowing" the ground when backing, not backing in 2 beat rhythm but dragging each hind leg back. Bunny hopping canter in the pasture.

    Neurologic horses often over-reach and hit themselves in the heel area, because they don't know where their feet are and the normal gait rhythm is delayed or screwed up.

    A pacing walk can *suggest* neurological issues. Recently I've learned that patella locking can be another sign.

    All of these can be seen on neurologically normal horses, but as a package, they can definitely suggest neurologic issues.

    One of the best sites for information about neurological deficits is equinewobbers.com. It's got tons of info.

    As to an EPM diagnosis, if the horse is neurologic, then the blood tests can rule out EPM, but even a positive test doesn't clearly diagnose it. The IFAT is rather controversial, but does give a "percentage" chance the horse has an active case of EPM. But again, I've talked to equine neurologic specialists who think it's too subjective, since the percentage is judged by an individual lab tech. Also the percentages are based on limited research.

    A diagnosis of spinal compression requires a myelogram.

    Many vets now are treating any neurologic horse that tests positive for EPM, as a default. The idea being that if the horse gets better, it must have been EPM. Having been through all this (can you tell?) I think that does make some sense, because the myelogram is quite hard on a horse, and expensive too. And if a horse does turn out to have spinal compression, the treatments are either very limited or major surgery.

    There is also the Vitamin E thing, in which some young horses become neurologic and when treated with vit E, recover. All horses which show neurologic symptoms are generally put on Vit E, with the idea that it helps the nervous system regenerate.



  6. #6
    Join Date
    Jun. 10, 2008
    Location
    Southern by the grace of God
    Posts
    455

    Default

    Quote Originally Posted by flyracing View Post
    To answer you first question. Yes, I think epm is an overdiagnosed catch-all when the horse has deficits on the nuero exam and the vet can't figure out why... but that doesn't mean it's rare, because I don't think thats the case either. When I first moved to Texas, I had never heard of EPM because I came from a part of the country that doesn't have opposems and therefore the only cases of epm the vets see are horses shipped in from other areas that were dormant carriers that became active.
    I agree with flyracing and do think it is over diagnosed, specifically when the vet can not figure out what exactly is wrong. there is no specific test for diagnosing EPM, it comes from signs and a spinal tap that may or may not present with I think they are spirochetes in the fluid- which doesn't indicate the horse has the disease and then you treat and hope it works.

    I did have a horse diagnosed with EPM back in 2001. He is 19 this year and fat and happy and just retired from interemediate level eventing this spring. I bought the horse in OK in the spring of 1999 as a bn eventer. On the prepurchase we did have a spinal tap done and he did test positive for the spirochete (or whatever it is their looking for) and just meant he had been exposed to the disease, not necesarrily has it. EPM is very very rampant in TX and OK and surrounding areas, and most horses in that area test positive with a spinal tap, but again, doesn't mean they have the diease or will succumb to it. They are spread by possums and armadillos and other varmits pooing in the pastures on the horse's gras and the horses eating it.

    During the summer of 2000, a very HOT summer in TX, but I guess they all are, we were doing a lot of traveling showing between TX, LA and NM and OK and at some point, the horse got over stressed/ hot which resulted in him getting EPM from the spirochetes (again or whatever) in him.

    We first noticed that the horse, when leading in from the pasture one evening, fell flat on his face walking into the barn- which never happens, heck I was eventing at prelim at the time- so very athletic horse. So we took him straight into the vet the next day. Of course they did a spinal tap again (came back positive) which we knew would alread. We didn't have any muscle loss, just coordination/ balance loss. We started him on a treatment right away. My mom is involved in the animal health industry and knew about an experimental drug that they were testing for EPM in Canada. It wasn't available at the time in the states (and I couldn't tell you what it eventually became) but we were able to get the product for him. It was 3 months of 2x daily dosing of a white liquid and then 6 months of rest.

    At the end of the treatment and rest, he was okayed to start back in work and we monitered him along the way. Well, the treatment worked and he came back to full eventing competition work, did a few 3 days and ran thru intermediate up until this spring when I decided to retire him because of a sinus inefection that the vets haven't been able to cure after 7 months of treatment and many antibiotics. If you were to look at him to this day, you would never know that he had had EPM. love that boy.



  7. #7
    Join Date
    Jun. 10, 2008
    Location
    Southern by the grace of God
    Posts
    455

    Default

    Quote Originally Posted by MelantheLLC View Post
    The clinical exam just shows neurological deficits, it doesn't tell you why they are there. Could be spinal compression (wobblers), EPM, or any of a number of other neurological issues.

    It also takes a very very good and experienced eye to see the subtle deficits. The scale is judged 1 to 5, a 1 being deficits which aren't readily apparent unless you do the tests, and a 5 being unable to stand.

    The tail pull is definitely subjective--sort of like flexions, depends on the person doing it. What is not subjective is "circumduction," where the horse is spun in a small circle and the outside hind leg swings out too far as he turns.

    This can be hard to see also. One neurological specialist told me that a vet should always stand back and watch while someone else spins the horse, because it's difficult to see if you are the handler.

    Another clue is how the horse puts down their feet, particularly when walked down a slope with their head raised. A neurological horse will "hover" the hooves, as if they don't quite know where the ground is. You kinda have to see this, it's hard to describe. But a normal horse places its feet on the ground with confidence, sort of like we walk normally, we just "know" where our feet will meet the ground and we just put them there, we don't feel for it.

    One more test that is fairly definitive is placing one front hoof across the other. Normal horses resist doing this, or if they do it, they will put their foot back within 30 seconds. This is a normal reflex action. A neurologic horse just stands there, not realizing where his feet are.

    ******

    As to other clues, dragging toes, knuckling the hind hooves frequently, stumbling, especially in downward transitions, "plowing" the ground when backing, not backing in 2 beat rhythm but dragging each hind leg back. Bunny hopping canter in the pasture.

    Neurologic horses often over-reach and hit themselves in the heel area, because they don't know where their feet are and the normal gait rhythm is delayed or screwed up.

    A pacing walk can *suggest* neurological issues. Recently I've learned that patella locking can be another sign.

    All of these can be seen on neurologically normal horses, but as a package, they can definitely suggest neurologic issues.

    One of the best sites for information about neurological deficits is equinewobbers.com. It's got tons of info.

    As to an EPM diagnosis, if the horse is neurologic, then the blood tests can rule out EPM, but even a positive test doesn't clearly diagnose it. The IFAT is rather controversial, but does give a "percentage" chance the horse has an active case of EPM. But again, I've talked to equine neurologic specialists who think it's too subjective, since the percentage is judged by an individual lab tech. Also the percentages are based on limited research.

    A diagnosis of spinal compression requires a myelogram.

    Many vets now are treating any neurologic horse that tests positive for EPM, as a default. The idea being that if the horse gets better, it must have been EPM. Having been through all this (can you tell?) I think that does make some sense, because the myelogram is quite hard on a horse, and expensive too. And if a horse does turn out to have spinal compression, the treatments are either very limited or major surgery.

    There is also the Vitamin E thing, in which some young horses become neurologic and when treated with vit E, recover. All horses which show neurologic symptoms are generally put on Vit E, with the idea that it helps the nervous system regenerate.

    Fantastic information!!!!



  8. #8
    Join Date
    Oct. 26, 2006
    Posts
    42

    Default

    Thank you for sharing your stories and truly helpful information. You guys are the best.

    I would love to hear which drugs you used for treatment and which you believe were most effective. I am also still hoping to learn more about the Diclazuril.



  9. #9
    Join Date
    Jan. 2, 2010
    Location
    Columbia, SC
    Posts
    867

    Default

    Only because this is tagged and can be a resource for other EPM sufferers, I will share my story.

    Had a horse who showed typical signs--ataxia and atrophy, etc etc. Called the vet to have a neurological exam done--and she performed a test in which she covered his eyes up and then made him walk and turn. He fell over almost instantly. Started him immediately on the Marquis treatment and showed little improvement--the day we found him fallen and unable to stand was the day we had to put him down...all of this happened within 2 months. The vet was sure he had EPM, and he tested positive (but in the southeast, what horse doesn't.) We could not believe how rapidly he was progressing.

    When the autopsy came back, it was WEST NILE. I wholeheartedly agree that we too-soon look at EPM for our neurological problems. Be sure to inquire about any and all possibilities, even if they are region specific.



  10. #10
    Join Date
    Jan. 18, 2009
    Location
    Pacific NW
    Posts
    2,322

    Default

    Quote Originally Posted by Party Doll View Post

    Also do you think that epm rare, or common and underdiagnosed? My vet seems to think its common, but I am leary of it being a catch-all diagnosis.

    .
    I asked one of the leading EPM researchers in the world this exact question earlier this year. The answer was it is both over and underdiagnosed. There are areas where it is rampant and often not diagnosed, but it is also a catch all diagnosis in some places... it's a tricky one.....
    Turn off the computer and go ride!



  11. #11
    Join Date
    Jul. 18, 2007
    Location
    Seabeck, WA
    Posts
    330

    Default

    Quote Originally Posted by foggybok View Post
    I asked one of the leading EPM researchers in the world this exact question earlier this year. The answer was it is both over and underdiagnosed. There are areas where it is rampant and often not diagnosed, but it is also a catch all diagnosis in some places... it's a tricky one.....
    My vet said exactly the same thing! He felt that it was overdiagnosed for acute cases, but underdiagnosed in horses who could keep working through it.



  12. #12
    Join Date
    Jan. 16, 2002
    Location
    West Coast of Michigan
    Posts
    36,325

    Default

    My experience:

    My 20 y/o event mare got a little stiff after we'd gone to a H/J show and done a bunch of classes, some on hard ground. I figured she'd worked hard, gave her a week off, but she never quite came right. Just seemed creaky and stiff behind. Nothing shocking considering her age, mileage, etc.

    In the same time frame she developed a habit of rubbing her tail, nothing major but new for her. I also began to notice she'd sweat in patches, only on one side of her body. Not a lot, but new. Didn't put two and two together at first, because none of these things in isolation was anything more than "mild".

    After maybe 2-3 weeks of this, waxing and waning, with her otherwise being normal, she quite suddenly (over the course of a day or two) began staggering and having a hard time turning to the right. She carried her head a little tilted, and walked in a sort of permanent half-pass left, instead of straight lines. Much more sweating on the right (? hard time remembering ?) side and tail rubbing.

    IMO the only way to make the diagnosis is with spinal tap, and we diagnosed her and I started the Marquis within 2 days. She got the traditional 28-day course, which she tolerated very well without any sharp deterioration. She gradually started to get better after the 2nd week--sweating, tail rubbing, and ataxia improved dramatically. She remained non-toxic, not depressed, good appetite and demeanor throughout.

    After her course of Marquis, I had a horse who was about 95% normal. She could walk, trot, canter, virtually normally, but had just a slight residual weakness in her hind end, for all I know also related to her age and creaky hocks, which had been a growing but manageable issue prior to her illness. The bottom line was, she could be ridden but I never pointed her at a jump again because she WOULD jump it, and I wasn't sure her body would be able to cash the checks her heart and brain would be writing.

    So she retired, we had an occasional little hack, and she ate grass and hung out and enjoyed herself.

    Two years later, almost to the week, without showing any other signs, she came in from the pasture having done a lot of running (I took her pasture buddy away, something she normally objected to but not this strenuously) and having obviously fallen--grass stains on her hocks, etc. She either injured her neck or the EPM came back with a vengeance, because she was horribly ataxic and barely able to walk. Within 3-4 days she'd deteriorated to the point where I had to have her euthanized.

    I'm not sure if her final deterioration was the EPM or an injury, but we never had a chance to treat her that time because she deteriorated so fast and was so miserable there was only one option.

    Bottom line--I would want the best possible chance at an accurate diagnosis, and if the diagnosis were certain or even "highly likely" I would treat according to current guidelines and based on the best veterinary expertise available. It's nebulous and difficult enough without resorting to regimens that are based on no data and half-baked theories.
    Click here before you buy.



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