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My guy is getting tested for EPM...

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  • My guy is getting tested for EPM...

    So yesterday while I was sitting at my desk at work a lightbulb went off in my head... I need to test my 14 y/o TB jumper for EPM.

    My main concern: In the past 3 years there have been 3 separate occassions where he has completely wiped out w/ a rider on him (thankfully he nor I were hurt). Two of the times with me were at a collected canter, in OK footing. I chalked it up to a freak accident & the OK footing. The other time was when I was away at college and he wiped out in the mud w/ the girl who was leasing him.

    A few other things: Some days he will come out a little cold backed. He has lost his confidence over the past few years (there was one point where he wouldn't even go over a ground pole), even though he has had confident and professional riders. Even on the ground, he has been acting "flustered" for lack of a better word.

    It's just my intuition... where we live horses turn up positive w/ EPM all the time. I just know this horse extremely well and it fits all the signs. I have taken excellent care of him, checked out all soundness issues, tested for Lyme, etc, etc.

    I have so many questions.. if he comes up positive, how fast does this disease degenerate them? No more jumping/riding? I know my vet highly recommends Navigator and I believe he still has some even though they don't make it anymore. Please help, I'm so stressed!

  • #2
    Each horse is going to react and recover differently. Mine (about 8 months after treatment with Navigator) is almost back to normal. The vet thinks that he'll make a full recovery with appropriate work, and will be fine to ride and jump. The same vet also treated his horse with Navigator and the horse had a made a full recovery. The horse had been NQR for almost a year prior.

    I'm sorry to hear they're discontinuing Navigator! Any idea why?


    • #3
      I'm sorry to hear that your horse might have EPM. What tests are you doing?

      My horse came down with it last June (and seems to have recovered completely! though we're still taking it easy). One of the best resources I found is a yahoo group: http://pets.groups.yahoo.com/group/EPM/

      The ladies (and a few men) on the list are very helpful and supportive. They will push for a definitive diagnosis (they understand spinal taps aren't possible for everyone's situation, but to at least get the IFAT and eliminate other possibilities with other testing).

      From what I can tell, Navigator was discontinued because it was no longer profitable. It had more side effects than Marquis and Diclazuril (not commercially marketed yet) and they all seem to have about the same effectiveness.


      • #4
        You must be so worried!

        I had EPM flash through my mind yesterday when my horse completely ate it in the turnout. You just don't see horses wipe out very often.

        I have no information for you but I hope you let us know how it goes. I have heard that the recovery rate is very good, so I'll be keeping my fingers crossed for you.


        • Original Poster

          Originally posted by esdressage View Post
          You must be so worried!

          I had EPM flash through my mind yesterday when my horse completely ate it in the turnout. You just don't see horses wipe out very often.

          I have no information for you but I hope you let us know how it goes. I have heard that the recovery rate is very good, so I'll be keeping my fingers crossed for you.
          Thank you everyone... we're getting blood drawn tomorrow then going from there. No spinal tap, at least just yet. I don't want to put him through something that invasive unless I absolutely have to.


          • #6
            The sad reality is that none of the tests are absolutely foolproof (including the ELISA)- there are false positives and false negatives in every one of them. A Western Blot is useless- up to 80% of the equine population in any given area will show positive, due to exposure.

            Use your best judgement- but, one thing you can do NOW is start him on 10,000IU Vitamin E per day, and a high quality immune booster. Any drugs you use will quell the current attack, but your horse will need his immune system kicking to go on from there.

            Best of luck!
            When someone shows you who they are, BELIEVE them- Maya Angelou


            • #7
              Doesn't EPM usually effect the hind end more? I am just wondering.

              Honestly I think horses bite the dust more than we realize I have had 4 horses go all the way down or very very close to it while riding and seen a few more. They almost always trip with their front and crumple down (2 of the ones I rode did that) then there is the mud, hind end slips out trying to turn (one of the ones). Those 2 would not bother me unless it was frequently. The whole you are on your feet then not is the really scary one that would bother me more, but would also have to happen more than once.

              I would have a neuro exam done of course and if that is fine, I think I would think harder about it maybe being a training problem. You said you have him leased? You never know what is truly going on and maybe he had some bad rides and is sour now?


              • Original Poster

                Originally posted by whbar158 View Post
                Doesn't EPM usually effect the hind end more? I am just wondering.

                Honestly I think horses bite the dust more than we realize I have had 4 horses go all the way down or very very close to it while riding and seen a few more. They almost always trip with their front and crumple down (2 of the ones I rode did that) then there is the mud, hind end slips out trying to turn (one of the ones). Those 2 would not bother me unless it was frequently. The whole you are on your feet then not is the really scary one that would bother me more, but would also have to happen more than once.

                I would have a neuro exam done of course and if that is fine, I think I would think harder about it maybe being a training problem. You said you have him leased? You never know what is truly going on and maybe he had some bad rides and is sour now?
                Normally I would agree about the wiping out issue, but by wiping out, I mean full on somersault, both times. It's very scary when there's nothing in front of you, you face-plant to the ground, then see huge hindquarters coming behind you only to land on your back. I still think it's a miracle neither of us were injured! As for the leasing issue, he hasn't been leased for 2 years so I would hope any training problem would be diminished by now, but you never know what really went on when I was away at college. A couple of bad rides definitely could have went down.


                • Original Poster

                  Oh yes and I forgot to mention... the hind end. Some days he will come out uneven behind. It's so very slight and no one that didn't know the horse woudl think anything of it, but that was one more thing that drove me to get him tested.


                  • #10
                    I had a TWH gelding that was diagnosed with EPM a while back. It was very subtle in his rear end. I noticed a "wobble" and his gaits felt off. We did 10 weeks of Marquis but he relapsed worse than before and I later made the decision to euthanize him. It was hard to euthanize a horse that otherwise looked shiny, healthy and was very well trained and sweet.

                    Now I have a TB that I am learning dressage with. He is very sound but I am constantly paranoid he will develop EPM as well. I realize that the odds are against it, but I am constantly watching for neurological signs. Living in fear I guess. I wish Marquis was cheaper, I would give all my horses a months worth annually just like a 5 day powerpack for preventative reasons. They have all been exposed where we live, it is a very poorly understood disease. Why do young healthy horses sometimes develop symptoms and the older weaker pasturemates are unaffected?

                    FWIW I order Vitamin E from Platinum Performance. It is a palatable powder that is readily consumed.

                    I have used Vit E capsules from the store in the past and sometimes the horses won't eat them. Make sure you buy the D Vitamin E (Does more) rather than the synthetic DL Vitamin E (Does less).

                    Good luck with your horse.
                    "Right is right if nobody is right, and wrong is wrong if everybody is wrong."

                    -Archbishop Fulton Sheen


                    • #11
                      I also wanted to add this c/p from a human nutrition article that explains the difference between forms of Vitamin E. They are not equal.

                      Which form is best?

                      The names of all types of vitamin E begin with either “d” or “dl,” which refer to differences in chemical structure. The “d” form is natural (also known as RRR-alpha tocopherol) and “dl” is synthetic (more correctly known as all-rac-alpha tocopherol). The natural form is more active and better absorbed. Little is known about how the “unnatural” “l” portion of the synthetic “dl” form affects the body, though no clear toxicity has been discovered.

                      In theory, when a vitamin E supplement is labeled “400 IU” it should have the same level of activity regardless of its source. This is purportedly achieved by using more synthetic vitamin E to reach the same potency as a lesser amount of natural vitamin E. For example, 100 IU of vitamin E requires about 67 mg of the natural form but closer to 100 mg of the synthetic. However, a recent review of the scientific evidence suggests that natural vitamin E probably has greater activity in the body than indicated on the label.7 Natural vitamin E may be as much as twice as bioavailable as synthetic vitamin E, not 1.36 times as is generally accepted.8 Many doctors advise people to use only the natural, the “d” form, of vitamin E.

                      After the “d” or “dl” designation, often the Greek letter “alpha” appears, which also describes the structure. Synthetic “dl” vitamin E is found only in the alpha form—as in “dl-alpha tocopherol.” Natural vitamin E may be found either as alpha—as in “d-alpha tocopherol”—or in combination with beta, gamma, and delta, labeled “mixed”—as in mixed natural tocopherols.

                      Little is known about the importance of the beta and delta forms of vitamin E, but a debate has arisen concerning gamma tocopherol. In a test tube study, gamma tocopherol was found to be more effective than alpha tocopherol in protecting against certain specific types of oxidative damage.9 In addition, some research has shown that supplementation with large amounts of alpha tocopherol (such as 1,200 IU per day) increases the breakdown, and decreases blood levels, of gamma tocopherol.10

                      Human trials with vitamin E have almost always been done with the alpha (not gamma) form. Historically the synthetic “dl” form was used in most trials, but some trials are now using the natural form. The issue of alpha vs. gamma form requires more research before it can be fully understood.

                      Almost all vitamin E research shows that, when positive results are obtained, hundreds of units per day are required—an amount easily obtained with supplements but impossible with food. Therefore, switching to food sources, as suggested by some researchers, is impractical. On the other hand, the vitamin E occurring naturally in food contains gamma tocopherol and other tocopherols. Thus, it possibly may turn out to be more effective than the vitamin E taken in supplement form. Additional research is needed in this area.

                      Vitamin E forms are listed as either plain “tocopherol” or tocopheryl followed by the name of what is attached to it, as in “tocopheryl acetate.” The two forms are not greatly different. However, plain tocopherol may be absorbed a little better, while tocopheryl attached forms have a slightly better shelf life. Both forms are active when taken by mouth. However, the skin utilizes the tocopheryl forms very slowly,11 12 so those planning to apply vitamin E to the skin should buy plain tocopherol. In health food stores, the most common forms of vitamin E are d-alpha tocopherol and d-alpha tocopheryl acetate or succinate. Both of these d (natural) alpha forms are frequently recommended by doctors. Although the succinate form is slightly weaker than the acetate form, more milligrams of the succinate form are added to supplements to compensate for this small difference in potency. Therefore, 400 IU of either form should have equivalent potency.
                      "Right is right if nobody is right, and wrong is wrong if everybody is wrong."

                      -Archbishop Fulton Sheen


                      • #12
                        Though often seen with backend problems, EPM can can affect many different parts of the horse depending where in the spinal column the lesions are. Some have swallowing problems because the lesions are far forward, some have front end problems because the lesions are in the area that affects the front legs, etc.


                        • #13
                          Be sure to have a neurological reflex examination. You really need a clear-cut evaluation of whether he is normal or not. If he is normal in a neuro evaluation, even if he tests positive for serum EPM, it's not very likely he has the active disease. OTOH, if he is abnormal neurologically and tests positive, then the odds go up a lot more. In fact a lot of the expert vets on EPM are not even doing spinal taps anymore if the horse is abnormal neurologically and has a positive IFAT that indicates active disease.

                          Here's some quotes from a Bayer 2002 Roundtable on EPM:

                          Byars: I think EPM can look like anything it wants to
                          look like. However, if we see asymmetrical muscle
                          atrophy, as well as upper and lower motor neuron
                          signs, which are also asymmetrical to the limbs, we
                          suspect EPM.
                          Stephen Reed: Our diagnostic criteria are very similar.
                          We also think the neurologic exam is very critical.
                          We see symmetric ataxia frequently, probably more
                          than asymmetric ataxia. It’s not uncommon for us to
                          see some cranial nerve signs. In particular, we get a
                          number of horses with dysphagia. We will almost
                          always take cervical radiographs of suspected horses
                          and evaluate sagittal ratios to eliminate cervical vertebral
                          stenosis. We still collect CSF when the horses
                          are in our hospital. We also use the Western Blot as
                          a screening tool for horses we think are negative
                          for EPM because horses without EPM will almost
                          always have negative test results.
                          Bonnie Barr: Along with the neurologic exam,
                          we will usually make sure there is no evidence of
                          a musculoskeletal disorder. We also rely on cervical
                          radiographs and evaluate the sagittal ratio. In
                          addition, we often do myelograms on our patients,
                          in which case we have CSF to evaluate.
                          Stephen Russell: I rely almost exclusively on
                          clinical signs and may conduct a Western Blot of
                          serum. I rarely collect CSF for evaluation anymore.
                          Furr: I think most people have recognized the
                          problems there are in interpreting Western Blots
                          on spinal fluid. Currently, it is common for
                          treatment of EPM to be based primarily on clinical
                          signs and the clinician’s opinion. At
                          our practice, we generally do spinal
                          radiographs as part of the work-up.
                          I usually offer to collect CSF for the
                          sake of completeness. The one place
                          where I think it might be more
                          important to collect CSF is when we
                          suspect there might be a problem
                          other than EPM. Here on the East
                          Coast, we are seeing cases of West
                          Nile Virus. Any of the encephalitides
                          would certainly be a mitigating
                          factor for the collection of CSF.
                          There are other things that could cause neurological abnormality, several other diseases (though mostly very serious ones, in which case he'd be very sick more quickly) and the other biggie they mention, CVS (cervical vertebral stenosis,) or spinal compression.

                          Most importantly, get the full neurological evaluation before you get too fixated on something like EPM as an issue. It could be he is neurological, or it could be he has pain of some sort that creating this clumsiness.

                          There's a great description of neurological tests on this website.
                          The tests can be done right there on the spot, they are not fancy.
                          Ring the bells that still can ring
                          Forget your perfect offering
                          There is a crack in everything
                          That's how the light gets in.


                          • Original Poster

                            Yesterday we went to the clinic, and Dr. Barnes did a thorough neuro exam on my boy before drawing the blood. He had me stand my horse square and then he tried to put his left hind leg over his right leg. Apparently that is a very demeaning stance for a horse (I never knew this). My horse let him do it on the left side, but not the right (indicating a possible neuro issue). Then he had me walk away from him, watching the movement of his tail (normally the tail will sway with the motion) and my horse's tail apparently was motionless. He had me do a bunch of other little "tests" all of which my horse failed, but only on his left side.

                            About the slight lameness (more like asymmetrical-ness) issues, he said a lame horse will come out lame everyday. A horse with EPM will be fine one day, and come out off the next. I knew this, but hearing it from him made me even more happy I had him tested.

                            So, finally, Dr. Barnes said he would be very surprised if the test came back negative. He also said there are new tests out now that indicate it is "somewhat likely", "likely", "very likely" that the horse has EPM and was not just exposed to it.

                            I learned a lot at the clinic and am awaiting my results (probably going to get them on Friday), but I think I already know the answer.

                            I'm not happy by any means my boy has EPM, but I am happy that I finally pin pointed what was the matter. He's just such an athletic animal and has been off for some time now... an exhausting weekend :/


                            • #15
                              Keep us posted. If he is neurological then keep in mind that his recovery will take awhile, even if it's from EPM. You can get rid of the protozoa but the nerve damage remains and will take awhile to heal. (Or it may never heal, but cross that bridge if or when you come to it.)

                              I think there are a lot of horse out there with mild neurological deficits that never get diagnosed.
                              Ring the bells that still can ring
                              Forget your perfect offering
                              There is a crack in everything
                              That's how the light gets in.


                              • Original Poster

                                I'm hoping I caught it early enough. Last night I couldn't stop beating myself up about not testing him sooner.


                                • Original Poster

                                  Does anyone have any promising stories about horses that have had EPM? Any happy endings out there??


                                  • #18
                                    A fellow boarder had a horse that they bought and soon found out he had EPM. They treated with Marquis and maybe something else prior to that. It was a very expensive treatment and his old owner ended up taking him back because they did like the horse and probably felt bad for all the money the girl was spending. They did one more round of treatment on him and I guess all is well. They're riding him regularly now.

                                    We found that the horse did better turned out with his mare companion (who was such a good watch mare by the way, it was very cute how she took care of him) in a decent sized turn out.

                                    I don't think he even actually fell over or anything like that. Just uneasy and almost looked drunk some days and had a really scary canter when he would occasionally try and canter in the turn out for a few strides.

                                    Keeping him on stall rest his was grumpy and hyper when you took him out which made it more scary because he was rather unbalanced as it was.

                                    I am not sure if this horse had a more severe case then yours though.


                                    • Original Poster

                                      It's great to hear he's rideable now. I'm so nervous. I just hope my guy gets to live out the rest of his life happy & healthy.


                                      • #20
                                        I was in your shoes about a month ago. Horse lost a lot of muscle through hindquarters and topline. It was more wastage than general wt. loss. He is a 17 hh, 15 yoa tb. I just thought the muscle wastage and wt loss was due to poor grass and hard winter. Try as I might, I could not put wt. on him. The vet came and did the neuro tests, which he passed. The blood test came back positive. I am on my 3rd week of Marquis-horse is beginning to look better. Don't beat yourself up on not finding out sooner. I felt the same way too. Not every horse is doomed. I hope yours makes a great recovery. If you use Marquis, be sure and give 1/2 cup corn oil. It helps the Marquis absorb better. The epm yahoo group is great-there is a link on another thread. The Marquis is expensive, but it is working for me. Good luck and keep everyone posted.