Like with Lyme, because the diseases are really so…weird, sometimes you just treat symptoms even if titers are iffy
Yes.
I had a horse who went from 1:2000 to 1:8000 (after giving marquis) to 1:1000 after protazil. This horse never showed clear symptoms but he was tripping which lead to first testing. Subsequent testing was follow up. Tripping turned out to be sore coffin joints. When I started doing pro stride in his coffins the tripping went away.
Another 1:2000 to 1:1000. I did protazil only.
If it’s not an economic issue for you, it’s not going to hurt, and if they have an issue it will help. Also add vitamin E at least while you treat.
My vet here always says 1:2000 is threshold to treat. I prefer to be aggressive in case it’s heading to a real problem.
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My 5 yo had similar symptoms…but we found Lyme and EPM at the same time (EPM titer was 1:8000). We treated a month with Protazil (I wanted to treat longer, vets said not needed)…totally back to his old self! We also had ulcers that were found just prior to the EPM…this was round two of ulcers, and he had been on some maintenance ulcer meds. So you may want to treat for ulcers along with the EPM meds.
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Yeah, totally agree. Even my iron stomach horse went off food with EPM treatment.
@Amberley if you go the ponazuril route, there’s evidence that oil dosed with it increases absorption into the CSF:
I used cocosoya rather than corn for palatability with the first horse, every subsequent one (I’m on my fourth horse this year running through EPM treatment, siiiiiiiiiiigh) I just use my standard veggie oil. The Farm Vet compounded ponazuril powder has proved palatable here, I’ve seen good results, and it’s just so inexpensive (although I hear you that dollars aren’t a concern.)
What’s the difference between toltrazuril and protazil and ponazuril?
Different drugs in the same class
Chiming in from a very high EPM area (sadly). We treat everything at 1:2000, and we treat below that if there is a symptom. Unfortunately the test just isn’t that great, so we try not to get too hung up on the exact number. Marquis is very safe and not something I worry about using in borderline cases.
My vet would suggest a month of Marquis, and a natural vitamin E supplement (at least 2000 iu). If the horse passed a neuro exam, she’d suggest he stay in light to moderate work.
I’d also run a Lyme titer on the horse.
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The research behind protazil is pretty uninspiring :-/
“Each horse’s response to treatment was compared to its pre-treatment values. Successful response to treatment was defined as clinical improvement of at least one grade by Day 48 ± conversion of CSF to Western Blot-negative status for S. neurona or achievement of Western Blot-negative CSF status without improvement of 1 ataxia grade.”
So they had to improve one grade OR convert to negative on the blot to be counted as a success.
“Based on the numbers of horses that seroconverted to negative Western Blot status, and the numbers of horses classified as successes by the clinical investigators, 28 of 42 horses (67%) at 1 mg/kg were considered successes.”
67% converted to negative or were considered improved one grade after a month of treatment.
“With regard to independent expert masked videotape assessments, 10 of 24 horses (42%) at 1 mg/kg were considered successes.”
But only 42% improved one grade on the neuro exam when independent experts reviewed the video taped neuro exams.
I suspect my new horse has a mild case of EPM (leaning on the fence to rest, backend leaning to one side for a few seconds in washrack, a little uncoordinated…but he’s also very calm and lazy as well, so I’m not sure if that’s related) and the more I read, the more I lean toward the Orogin protocol, as well. Financially it seems to make sense, and though the results are pretty anecdotal, I sure am finding a lot of them sharing success stories.
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Man, I don’t disagree that there are positive stories out there and obviously some are fans, but wow it’s just such a shame there’s no data.
Anecdotes just aren’t research, and without real actual research it’s just impossible to know how it compares to the drugs we have that have been studied, or how effective it really is.
It sure would be helpful if those that use it and prefer it over the FDA approved options would at least track and publish their outcomes. That no referral or teaching hospital has run a study is kinda curious (and perhaps concerning, idk.)
Here’s an interesting paper about how people value anecdotes in general and struggle applying data to decision making. We’re just wired to be bad at it :-/
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I realize this is outside the conversation, but what I’ve seen around here is that almost all of the horses tested seem to show up in that exposure range. I know you’re focused on EPM, but/and while I had a friend treat with pretty much this same kind of behavior in the horse, it didn’t change after Marquis. Another possible explanation was arthritis at C5-6. So - maybe?
This is the first time I have heard of this treatment for EPM. I’ve shared the story of my horse, who was diagnosed a year ago with EPM. It took months for vets to figure out what was wrong because his symptoms were so vague. They threw the kitchen sink at him before he was diagnosed and the only thing that made a difference was treatment for ulcers. After doing some research, I found ulcers are a problem caused by EPM. The link to the Sunny Coast Vet clinic (posted earlier in the thread) explains why. My vets were not aware of this.
Once we got a diagnosis, I started treatment with Protazil. I have used it on and off for a full year. (He may have had at least one relapse.) His titer level before treatment was 1:2560, after two months on a full dose 1:1280, after one year on a periodic 1/2 dose, 1:320. My vet wants to keep him on 1/2 dose per day to get his numbers down even more. He gets Vitamin E along with the Protazil.
Here’s where things got complicated. Even with the dramatic reduction in titer numbers, he still wasn’t right. Ever since buying him, he has had a an issue with contact that would come and go. I finally found a bit he liked and it improved, but never totally went away. I decided to do a full work-up, with x-rays of his back, neck, head and TMJ. All were negative for problems. Flexions revealed some discomfort in his stifles and x-rays showed slight remodeling in both stifles. He was injected and there has been a notable improvement, especially with the contact issue.
This horse has never been in heavy work, so the stifle issue is a mystery. I don’t know if there is a connection to EPM, for example, stress from loss of muscle control and strength in his hind end. I plan to use Pro-Stride and continue maintenance as needed. In my 50+ years of horse ownership, I’ve never had such a frustrating and stressful experience.
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My understanding is that there are 3 types of protazoans that cause epm. Marquis only treats one type which explains why it works for one horse but not another. I successfully used Pathogenes protocol with Oragen and lavamisol. We had to treat twice ND extended the treatment the second time and kept her on the oragen for longer, but it did work. We are just finished her 3rd treatment 1 1/2 years later due to a slight relapse.
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No, this is not correct.
https://onlinelibrary.wiley.com/doi/10.1111/j.1939-1676.2007.tb01966.x
Click the “download PDF” link to access the full paper.
Additionally, I think it’s useful to mention that the consistent recommendation when reviewing EPM literature, including that discussing N. hughesi, is
“Recommended treatment is use of an FDA-approved anticoccidial drug formulation.”
Like here
Unless I’m not reading things right, not only did N hughesi not decrease, it actually increased, and by a factor of 5. 2,560 before 60 days of ponazuril, 10,240 after.
But of course they’re only going to recommend an approved treatment
“Diagnoses of EPM associated with N hughesi and PSSM were made, and the gelding was treated with a 45-day course of ponazuril (5 mg/kg PO q24h) and a 28-day course of vitamin E (10 IU/kg PO q24h). Diet recommendations included feeding 16–20 lb (1.5–2% body weight) of good-quality grass hay along with 1 cup of corn oil daily. Recommendations also included pasture turnout. An evaluation by the referring veterinarian after 4 weeks of treatment with ponazuril revealed complete resolution of the ataxia and a normal pelvic limb gait. Repeat serology for N hughesi demonstrated a decreasing serum titer at 6-weeks postdischarge (320)”
“The EPM IFAT was positive for N hughesi (20). A diagnosis ofEPM due to Nhughesi was assigned. The filly was started on a course of ponazuril (5 mg/kg PO q24h) for 30 days. Serum from the dam was tested for EPM via IFAT and was negative for S neurona and positive for N hughesi at a titer of 640. A neurologic examination of the filly was performed 30 days after cessation of treatment with ponazuril, and although the filly remained ataxic (grade 1 of 5), the ataxia had improved. Clinical signs of respiratory disease had completely resolved at that time. The owners elected not to pursue further treatment of the EPM, and a further follow-up neurologic examination 6 months after presentation revealed complete resolution of neurologic signs.”
This is such a bonkers thing to say. If there was data showing effectiveness, it would be mentioned. Older papers do mention it. More recent ones do not. It’s not that it’s not FDA approved, JB. It’s that there’s literally zero quality research. As someone who has valued data highly, and cautioned against weighing testimonials and anecdote too highly, this is a weird stand for you. Are you okay? It seems really unlike you to just not care about the lack of data, or to not read past the first paragraph of a paper.
And to be clear, I’m not at all saying deconquinate/levamisole doesn’t work. With no quality research we have no idea how effective it is, or how it stacks up to the therapies that have been studied. Anecdote does not equal data.
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where is that? It’s not in your first link which is what I was referencing. No filly in the first link, no 45 day treatment, so you’re pulling from another study.
It is literally in the paper linked above. As I said in that post: click the link at that page that says “download PDF” and read the entire thing.
Are you okay? I’m worried about you.
Geeze, really? I’m sorry I missed the tiny, light gray text at the very bottom corner. USUALLY these things are in a nice box to download the pdf.
“A treatment protocol for EPM due to N hughesi has
not been described. Unlike S neurona, Neospora spp. can
form tissue cysts, and it has been suggested that because
of this tissue cyst stage, the parasite would remain
refractory to treatment.”
The point is that despite the idea that Marquis “treats all 3 types of protozoa”, the fact is that it might, but also might not, actually do anything about N. hughesi, as attested to by the fact that the first horse in that study had his level rise by 5x after 60 days of treatment.
Yes, EPM is complicated, it’s not simple to kill the protozoa.
Good luck to the OP, there are several options to try.
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