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EPM: Anyone ever had a EPM diagnosis where the only symptom was VISIOn changes?

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  • EPM: Anyone ever had a EPM diagnosis where the only symptom was VISIOn changes?

    So now I'm really puzzled. I posed here about my horse's vision problems...

    http://www.chronofhorse.com/forum/sh...periences-LONG

    He's now had issues in the EYE ruled out (brain and optic nerve issues could still cause vision changes but the eye itself seem to be normal per 3 vets, one an eye specialist). Bloodwork didn't really answer any questions either. The only significant findings are low white blood cell count (like he's fighting an infection) and exposure to EPM. I do not have the bloodwork results in written form yet, but he had a blood test done not the spinal tap. My understanding is that about 50% of tested horses come back exposed and you need a more sensitive test to really determine if there's an active EPM infection.

    Here's the part that throws me for a loop. I have been around horses with EPM, twice. This horse is nothing like that and appears to have no "body neurological" symptoms. He's able to walk, trot, canter and do his changes. If you cross his legs, he uncrosses them. If you pull his tail he reacts normally. He was evaluated by a TOP sports medicine vet who did not view the horse as showing signs of being neurological.

    His ONLY symptom is acting like he can't see properly. From googling, it appears vision changes can be a symptom of EPM. But he has NO other symptoms. No obvious neurology in the body. No muscle wasting. Has anyone ever had a horse or heard of a horse that had EPM and the only symptoms were vision changes?
    Last edited by vxf111; Jun. 9, 2013, 04:01 PM. Reason: typos
    ~Veronica
    "The Son Dee Times" "Sustained" "Somerset" "Franklin Square"
    http://photobucket.com/albums/y192/vxf111/

  • #2
    "Acting like he can't see properly" can mean a problem anywhere between the eyeball and the visual cortex in the back of the brain. Tough thing to sort out in a non-verbal animal!

    Perhaps the spinal tap might reveal more than a clarified status about EPM?
    Click here before you buy.

    Comment

    • Original Poster

      #3
      Originally posted by deltawave View Post
      "Acting like he can't see properly" can mean a problem anywhere between the eyeball and the visual cortex in the back of the brain. Tough thing to sort out in a non-verbal animal!

      Perhaps the spinal tap might reveal more than a clarified status about EPM?
      There's the rub, right? Can't see properly could be the eye, the nerves, or the brain. I am trying to decide if it's worth putting him through the spinal tap versus just treating as though we assume he has EPM. Or whether that entire line of thought (EPM) is a red herring...
      ~Veronica
      "The Son Dee Times" "Sustained" "Somerset" "Franklin Square"
      http://photobucket.com/albums/y192/vxf111/

      Comment


      • #4
        I have had some experience with EPM and vision changes with my mare. Though during her initial time she had EPM and now her first relapse she was showing right hind neurologic changes she did show vision issues.
        The first time they were so slight that me nor the vets involved in her case caught the vision problems. But in January she had a relapse after three years and it soon become obvious she did have limited vision in her left eye.
        The eye itself looks completely fine with her, so it somewhere in the nerve or brain that there is an issue. She was initially quite spooky when being ridden to the right with the left eye on the outside. It was big scary spooks too which are not normal for her.
        She did settle down some after treatment and seemed to become more comfortable with her vision. It is hard for me or my vet to say if she regained any vision or if she just adjusted to the loss in sight.
        I did still feel that at times she turns her whole head around to the left to get a good look at things like she still has some vision compromise.

        It is hard to say in your situation if it is EPM or not. But it is possible for the protozoa to attack any nerve in the body so the optic nerve is not out of the question.
        I did do the spinal tap the first time with my mare as she had very minor ataxia in the hind end, and the blood work came back iffy on active EPM.

        Good luck on whatever you decide to do!!
        Free and Forward Motion through Massage Therapy
        www.amandastarrbodywork.com

        Comment


        • #5
          yes, which is why I asked if you had ruled it out. Gosh I hope you can get to the bottom of this!!!!
          "You can't really debate with someone who has a prescient invisible friend"
          carolprudm

          Comment


          • #6
            There are two blood tests, one for each organism that causes EPM. You need a specialist to interpret the results, because they are based on ranges in your geographic area.

            I had a PPE done on one of my horses, the inspecting vet claimed the animal had EPM after doing the circle test pulling on the tail. He wanted to "treat" the animal without any formal tests and retest in a month. I said no, as there had been no symptoms, outside of his PPE. We took the horse to clinic with two neurological specialists. They did their tests, said no, but to cover our butts we drew blood and had the tests run (around $300 I want to say). They did not recommend the spinal tap. One test came back as zero/no exposure. The other test was in the low range for exposure for the geographic area, but NOT what would be considered for a horse showing symptoms of EPM.

            My advice is get yourself a neurological specialist that is familiar with your geographic area. Send the blood test results to them and ask for a another opinion. Treatment, which ever medicine you use, has some nasty side effects.

            Comment


            • #7
              My vet used to say that the only consistent thing about EPM symptoms is their inconsistency. It can be anything as the parasites can be anywhere in the central nervous system.

              Comment


              • #8
                Man 300 for epm bw. Glad my vet isn't that expensive lol.

                Epm can throw out all kinds of symptoms. It is possible that her only symptom is vision issues. In the early stages of my guys the only symptom was dropping food. Then the tripping came later. It's hard to say. Did they draw a crp on him? This well help determine if there is any inflammation anywhere. Seems that epm will cause inflammation in the brain and the crp test can show inflammation in the bw yet it doesn't tell you where it's at. I would probably draw the crp bw and if that came back high I would treat as if she had epm and go from there. Jmo.
                Horses aren't our whole life, but makes our life whole

                Comment

                • Original Poster

                  #9
                  What does CRP stand for?
                  ~Veronica
                  "The Son Dee Times" "Sustained" "Somerset" "Franklin Square"
                  http://photobucket.com/albums/y192/vxf111/

                  Comment

                  • Original Poster

                    #10
                    I now have the bloodwork in hand. It's from Equine Diagnostic Solutions in Kentucky. The test was "Sarcocustis neurona Titer on serum." The "combined SAG 2, 3, 4, Titer on serum" is "1:500" (or 1:400, it's slightly hard to read). Then it says "Positive specific antibodies were detected. This result indicates exposure to S. neurona, a causative agent of equine protozoal myelitis (EPM). It does not confirm clinical disease. Serium titers range from <1:250 (negative) to >1:4000 (high)."

                    So I take it this result is on the fairly low end, though some horses show so much less exposure that you call their titer a "negative."?
                    ~Veronica
                    "The Son Dee Times" "Sustained" "Somerset" "Franklin Square"
                    http://photobucket.com/albums/y192/vxf111/

                    Comment


                    • #11
                      Do the Pathogenes test.
                      "You can't really debate with someone who has a prescient invisible friend"
                      carolprudm

                      Comment


                      • #12
                        Originally posted by csb View Post
                        My vet used to say that the only consistent thing about EPM symptoms is their inconsistency. It can be anything as the parasites can be anywhere in the central nervous system.
                        This!!! It can depend on where at that point in time, the organism has settled.
                        Some riders change their horse, they change their saddle, they change their teacher; they never change themselves.

                        Remember the horse does all the work, we just sit there and look pretty.

                        Comment


                        • #13
                          Crp is c-reactive protein. I would also suggest doing the pathogens test. That test different sags. I forget which ones off the top of my head. If you do tha one, a crp and the results you have it may help you decide what to do easier. A spinal tap is not full proof itself either with diagnosing epm. It's known to be better than just the one elisa test of course but with my dealings with epm I'd go the cheaper easier route with these 3 test and determine from there. It will not hurt the horse though to treat even if he is not a true positive also.
                          Horses aren't our whole life, but makes our life whole

                          Comment


                          • #14
                            The other problem with the bw testing with elisa is that if the epm is not in an active state at the time of testing then it may show low titers, this is why there are so many false results also with the testing. You could also wait and retest in 4 weeks and do this retesting every 4 weeks for a few months and see if the results stay them same.
                            Horses aren't our whole life, but makes our life whole

                            Comment


                            • #15
                              Are you still planning on taking him to New Bolton? What if you treat for EPM and it's something else? (This is offered in the spirit of "let's throw out ideas," not to second guess.)

                              Comment

                              • Original Poster

                                #16
                                I have not heard back from the vet today. I depending on what he says (and what the insurance company says!) I am leaning towards treating for EPM (which then raises the "Marquis or something else" question) and seeing if the horse demonstrably improves. And not going to New Bolton until I've tried this. I am not sure what more they could tell me that is treatable if it is not EPM. That mostly only leaves the brain/nerves and I am not sure how realistic it is to explain there to be a curable/treatable problem there.

                                I am also still waiting on 2 (unlikely) blood results-- PSSM and Vitamin E.
                                ~Veronica
                                "The Son Dee Times" "Sustained" "Somerset" "Franklin Square"
                                http://photobucket.com/albums/y192/vxf111/

                                Comment


                                • #17
                                  Do the Pathogenes test...sorry to sound like a broken record, but it could help you a lot towards ruling it out. I have a 4yr old that had begun acting strangely, including weird vision issues, (she JUMPED a handful of grass clippings in the ring, but had begun refusing at crossrails) and she came back really high on only one of the antibodies on the Pathogenes test. We gave her the Oroquin, and on day 5 of treatment, I had my filly back! She was just champion at her first show two weeks ago. April 1st I would have told you she was done.
                                  "You can't really debate with someone who has a prescient invisible friend"
                                  carolprudm

                                  Comment

                                  • Original Poster

                                    #18
                                    Would it change the treatment, having better test results? Or you're thinking it might rule OUT EPM?
                                    ~Veronica
                                    "The Son Dee Times" "Sustained" "Somerset" "Franklin Square"
                                    http://photobucket.com/albums/y192/vxf111/

                                    Comment


                                    • #19
                                      IMO EPM is over diagnosed, an easy catchall for any unexplained nuerological dilemma. BE SURE before you spend your $1000 on Marquis, because if you don't get the result you are seeking following the 1st round, the vet will just suggest ANOTHER $1000 dose.

                                      Also, exposure to EPM is NOT the same thing as HAVING EPM.

                                      Comment

                                      • Original Poster

                                        #20
                                        Okay, referring vet says it's time for New Bolton
                                        ~Veronica
                                        "The Son Dee Times" "Sustained" "Somerset" "Franklin Square"
                                        http://photobucket.com/albums/y192/vxf111/

                                        Comment

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