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EPM Diagnosis - Prognosis

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    EPM Diagnosis - Prognosis

    I would like to tap into the collective mind hive of COTH to ask what has been the experience/prognosis for your horses with EPM.

    Back 3-4 years ago, I have a horse who tested at 1:4000 on the EPM test. He was treated with two courses of Marquis. Fast forward to today, a new blood test shows EPM numbers of 1:8000.

    One vet says this is just normal and indicative of the immune response to past exposure. Another vet says, No....these numbers are a sign of a current positive infection.

    Oh wise COTH....what say ye.....
    Do not confuse motion and progress. A rocking horse keeps moving but does not make any progress.
    Alfred A. Montapert

    #2
    What did he test after treatment the first time? All of ours have gone back down after treatment, although not all down to nothing. If the titer goes back up, we treat again.

    Comment

      Original Poster

      #3
      Originally posted by joiedevie99 View Post
      What did he test after treatment the first time? All of ours have gone back down after treatment, although not all down to nothing. If the titer goes back up, we treat again.
      The titre went from 1:4000 to 1:2000. 4 years later it is back up to 1:8000. One vet says it is "normal" and just shows that the horse is exposed. Another vet says, No, this is positive.
      Do not confuse motion and progress. A rocking horse keeps moving but does not make any progress.
      Alfred A. Montapert

      Comment


        #4
        Does he show symptoms? I know 2 people both who euthanized their EPM horses eventually. I know a vet who owns an EPM horse. She maintains him on medication and never takes him off it.

        Comment


          #5
          Since there is no cure, they will always test positive. My guy was 30 when he contracted EPM, treated with Marquis and followed up with Protazil and steriods during flares. That was two years ago and he's still kicking. He gets Protazil 3x a week and gets prednisolone EOD. I have him on natural vitamin E and he also has cushings.

          I think it depends on the symptoms. He did alot of spinning when first diagnosed but that decreased over time with treatment. Now, he walks a bit sideways at times (again, he's 32) but otherwise he's bright, happy and full of life. It's a horrible disease and I wouldn't wish this on anyone. I know his quality of life is good and he's not a danger to himself or others. We take precautions when leading him and just let him go when he needs to rotate to get himself aligned again.

          I wish you well and hope for a good outcome for your boy!
          Be blessed
          )O(
          "Some people will never like you because your spirit irritates their demons"

          Comment


            #6
            My 26 yr old OTTB had it, I'm sure he (and all my horses) carried it. He showed neurological symptoms, weakness in the hind end was the worst and sadly was the one I missed early on because he had suffered a fractured hip racing so he was wonky in the back end to begin with. Unfortunately his symptoms got worse, he was tested and his blood work was really high. We started him on Rebalance, did 2 rounds because the manufacturer was out of Protazil and was going to be out for an extended period so we went to something else. Regretfully his eye sight was compromised and his back end became too weak, he would fall and then not be able to get up, we elected to euthanize at this point. I wish we had tested early and got him on treatments.

            Comment

              Original Poster

              #7
              To answer questions, the horse shows minor symptoms....he is the classic, "not quite right." He presents by throwing the haunches in to the left, but will go straight if you ask. When he was treated before, the symptoms went away.

              The horse is 25 and is my special horse. Three vets looked and thought he was just getting older. The EPM diagnosis was just a fluke as that was just done to eliminate it along with Lyme. The horse is also PPID/Cushings, so use of oral steroids are not recommended due to the potential for laminitis.
              Do not confuse motion and progress. A rocking horse keeps moving but does not make any progress.
              Alfred A. Montapert

              Comment


                #8
                My very elementary understanding is that general exposure numbers are in the 1:## (tens) range, maybe low hundreds. 1:#### (thousands) would indicate active infection.

                Comment


                  #9
                  Originally posted by pluvinel View Post
                  To answer questions, the horse shows minor symptoms....he is the classic, "not quite right." He presents by throwing the haunches in to the left, but will go straight if you ask. When he was treated before, the symptoms went away.

                  The horse is 25 and is my special horse. Three vets looked and thought he was just getting older. The EPM diagnosis was just a fluke as that was just done to eliminate it along with Lyme. The horse is also PPID/Cushings, so use of oral steroids are not recommended due to the potential for laminitis.
                  I'm so sorry pluvinel, it just sucks. It's so hard on the older ones too. FWIW, the steriod dose my boy is on is low enough to keep him straight without compromising his Cushings. It does make a world of difference, and it doesn't mean he has to stay on them forever. Sometimes it's just to get them over the hump and then they can back off again.

                  (((hugs)))
                  "Some people will never like you because your spirit irritates their demons"

                  Comment

                    Original Poster

                    #10
                    Originally posted by MoonWitch View Post

                    I'm so sorry pluvinel, it just sucks. It's so hard on the older ones too. FWIW, the steriod dose my boy is on is low enough to keep him straight without compromising his Cushings. It does make a world of difference, and it doesn't mean he has to stay on them forever. Sometimes it's just to get them over the hump and then they can back off again.

                    (((hugs)))
                    Thanks....good to know. We are finishing up week 4 of Marquis. I will ask vet(s) what's next....including continuing meds and/or some level of steroids.
                    Do not confuse motion and progress. A rocking horse keeps moving but does not make any progress.
                    Alfred A. Montapert

                    Comment


                      #11
                      My horse got EPM when she was 4 and the greatest effect was her hindquarters (scientifically - left butt). We treated with Marquis? Maybe? I think not, I think the next step down. She had a little relapse the following summer and was treated again. Since then it has just mostly been monitoring, though she has been on monthly Adequan for about a year now (I know, Adequan is not best monthly, supposedly, but it works for her).

                      She is 9 now and doing fine. To be clear, we never did the actual EPM test. It is expensive and invasive and my vet recommended that they would treat my horse the same not matter the result (EPM or another neurological/parasitic issue).

                      Comment

                        Original Poster

                        #12
                        Originally posted by Ajierene View Post
                        My horse got EPM when she was 4 and the greatest effect was her hindquarters (scientifically - left butt). We treated with Marquis? Maybe? I think not, I think the next step down. She had a little relapse the following summer and was treated again. Since then it has just mostly been monitoring, though she has been on monthly Adequan for about a year now (I know, Adequan is not best monthly, supposedly, but it works for her).

                        She is 9 now and doing fine. To be clear, we never did the actual EPM test. It is expensive and invasive and my vet recommended that they would treat my horse the same not matter the result (EPM or another neurological/parasitic issue).
                        There are two tests for EPM. One is a blood test that tests for an antibody response.

                        The other is the "invasive" spinal tap of the cerebrospinal fluid (CSF) to test for the actual parasite. The CSF test has a number of potential complications and can also give erroneous info if the CSF is contaminate with blood.....so in a lot of cases vets prefer the spinal tap is not done.

                        I chose to have the blood test done which is why one of the vets was saying the numbers reflected the immune response
                        Do not confuse motion and progress. A rocking horse keeps moving but does not make any progress.
                        Alfred A. Montapert

                        Comment


                          #13
                          Originally posted by pluvinel View Post

                          There are two tests for EPM. One is a blood test that tests for an antibody response.

                          The other is the "invasive" spinal tap of the cerebrospinal fluid (CSF) to test for the actual parasite. The CSF test has a number of potential complications and can also give erroneous info if the CSF is contaminate with blood.....so in a lot of cases vets prefer the spinal tap is not done.

                          I chose to have the blood test done which is why one of the vets was saying the numbers reflected the immune response
                          OK, maybe that was it - the blood test was done? Maybe nothing was - that's also entirely possible. I just looked it up and yeah, blood test will show antibodies but the horse may not be effected by EPM. Some 20 years ago, I had a yearling arrive from Canada with EPM (that's the assumption - she wasn't showing symptoms when she arrived but the right side of her face fell not long after arriving). She ended up with a permanently droopy lip but her eyelid and ear returned to normal. We took her to a vet clinic when we noticed the face issue and were told the same thing - pretty much treat all the same to testing is a waste of time.

                          So, that seems to be the prevalent theory around here - if they show XYZ symptoms, skip all the formalities and treat.

                          That's different than your scenario where you were ruling it out.

                          Comment


                            #14
                            The thing is with EPM is that most horses will be exposed to the parasite but the immune system is strong enough to fight it off. Younger, older or those with compromised immune systems will have a greater chance of having symptoms and permanent damage. Since you can't kill it and there is no cure, you can only hope to lessen the degree of damage done neurologically and hope to keep the symptoms under control. Therefore, blood tests will only show if they have been exposure and the immune system response. Most will show symptoms first, hence the blood test and and then the probable conclusion that it is EPM.
                            "Some people will never like you because your spirit irritates their demons"

                            Comment


                              #15
                              My horse had a high titer, so we rechecked to make sure it went down. After Orogin, Protazil and Neuroquel, the titer finally started decreasing and went to negative. He has been healthy for 4 years now. Read the Pathogenes website. They have lots of good info about EPM and related disorders.

                              Comment

                                Original Poster

                                #16
                                Originally posted by AKB View Post
                                My horse had a high titer, so we rechecked to make sure it went down. After Orogin, Protazil and Neuroquel, the titer finally started decreasing and went to negative. He has been healthy for 4 years now. Read the Pathogenes website. They have lots of good info about EPM and related disorders.
                                Thank you. This is very interesting....I am full of questions.

                                When did you test?
                                How long did you treat with each medicine?
                                How long after treatment did the titer test negative?
                                Do not confuse motion and progress. A rocking horse keeps moving but does not make any progress.
                                Alfred A. Montapert

                                Comment


                                  #17
                                  OP, we first tested 4 1/2 years ago. I purchased my horse knowing he was stopping at Training level fences cross country. I wondered if there was a health issue, but he had a normal vetting, despite my mentioning my concerns to the vet. On my first ride after getting him home, my friend rode behind me. She commented that his tail was very crooked. I worried more, and we sent the EPM test to Pathogenes, which is the vet’s usual lab for EPM tests. He was very positive. Most vets that I have talked with don’t do a repeat test. Since his signs were so subtle, we did repeat testing. After 3 days of Orogin, my horse’s tail was almost normal. His titer stayed high, so we kept treating. Finally, after ?10 days of Orogin, ?2 weeks of Neuroquel, and ? A month of Protazil, his titer started dropping. We tested every 3 month for 3 years. The titer went up once during that time, which prompted another few weeks of Neuroquel. It finally went to negative about a year ago. His tail continues to be normal and he never stops at a jump on those occasions when I let a friend jump him.

                                  EPM is hard to figure out. I feel fortunate that we figured out a treatment plan that worked for my horse. .

                                  Comment

                                    Original Poster

                                    #18
                                    Originally posted by AKB View Post
                                    OP, we first tested 4 1/2 years ago. I purchased my horse knowing he was stopping at Training level fences cross country. I wondered if there was a health issue, but he had a normal vetting, despite my mentioning my concerns to the vet. On my first ride after getting him home, my friend rode behind me. She commented that his tail was very crooked. I worried more, and we sent the EPM test to Pathogenes, which is the vet’s usual lab for EPM tests. He was very positive. Most vets that I have talked with don’t do a repeat test. Since his signs were so subtle, we did repeat testing. After 3 days of Orogin, my horse’s tail was almost normal. His titer stayed high, so we kept treating. Finally, after ?10 days of Orogin, ?2 weeks of Neuroquel, and ? A month of Protazil, his titer started dropping. We tested every 3 month for 3 years. The titer went up once during that time, which prompted another few weeks of Neuroquel. It finally went to negative about a year ago. His tail continues to be normal and he never stops at a jump on those occasions when I let a friend jump him.

                                    EPM is hard to figure out. I feel fortunate that we figured out a treatment plan that worked for my horse. .
                                    THANK YOU!!!!!

                                    This post is very helpful. We have just finished 4 weeks of the Marquis, (ponazuril) paste. I was just wondering about retesting for EPM and what to do about any follow-up medications.

                                    I will ask the vet. Thank you all again. This is truly my "once in a lifetime" horse.
                                    Do not confuse motion and progress. A rocking horse keeps moving but does not make any progress.
                                    Alfred A. Montapert

                                    Comment


                                      #19
                                      OP, talk with your vet. There are lots of controversies in managing EPM. Some vets use the protocol of Dr. Ellison at Pathogenes. Others use the more conventional and more expensive meds. We used a combination of meds. If your blood tests are going to Dr. Ellison, she is happy to talk with you and/or your vet. I talked with her repeatedly, and found her information to be useful and reassuring. I ride my horse almost every day and really want him to stay healthy.

                                      Comment


                                        #20
                                        Be aware that the Pathogenes product is not USDA approved. The company has been reprimanded in the past by USDA for its claims. They are very good at marketing, and some vets are on board with them.

                                        Comment

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