Improvement in 3 of 3 horses on the neuro exam and 2 of 3 horses on the titer is significantly more data than we have on deconquinate/levamisole’s ability to treat N. hughesi. And aligns pretty well to what has been demonstrated for S. neurona’s response to treatment.
Yes, we need more study on ponazuril and dicazuril and how effective they are on N. hughesi. But what we do have does indicate that ponazuril is at least somewhat effective. There is no data on deconquinate/levamisole.
FWIW, the WB is the most unreliable of the tests. Who did the testing (ie Cornell, or someone else?) Any reason they didn’t suggest a SAG ELISA test?
My horse just got diagnosed via high titers and leaning to one side while trotting. This came on quickly. He also sometimes has fecal water syndrome, and is older. I think gut issues may predispose them. I got the compounded Ponazuril. I was told the difference was that it is not the paste like Marquis. Praying it works.
You’re not alone. Gut dysfunction impacts the entire body in a negative way, and allows all sorts of opportunistic crud to take hold, whether it’s something that’s been lying “dormant” that the body has been suppressing, or that’s always around and just found a loophole to get in.
EPM meds, all of them, can be hard on the gut, so I would also work from that angle to support gastric and hind gut health
So, from personal experience, I had two horses get EPM in the same year. Both were treated with a TOLTRAZURIL/DMSO mix. I saw improvement in behavioral changes at 1 week and significant improvement overall at the 2 week mark. One horse has no symptoms by the 4 week mark, the other had one leftover symptom that he sometimes likes to cross his hind legs, but interestingly that symptom has almost completely gone away a year later.
Toltrazuril is easy to give (one dose a day, liquid) and it’s cheap ($250-$350 for the month) and in my experience it works well.
It may be advantageous for you to try a treatment for a month and wait for your preferred vet. You’d know if it’s helping by about 2 weeks in.
Also, forgot to mention, one of them had a ‘low positive’ titer.
He was on equioxx, so I think that’s how it got “in”. I’ve started alfalfa pellets, vitamin e, corn oil to potentiate the ponazuril and GUT is being shipped to me. He gets 16 hours on lots of grass, so I did not think about ulcers… Also the owner throws vegetables from his garden into the pasture. So I suppose that was a free buffet at night for possum. 
Hindsight.
This has a lot of info about EPM medications:
It’s a liquid, once a day. You squirt it in the mouth. I prefer it because you know the horse is getting all of the medication, and both horses that got EPM tend to not be the best about spilling. The liquid must not taste bad either because they would take it without a halter. I’d just squirt it in and then give them their grain.
Hi, How did you know your low positive really had EPM? Some say the tests are not accurate. My horse was fine after hock flexions, but started leaning to the left after stifle flexions. His SAG titer was 1:4000, but I am still not sure the stifle flexion did not aggravate some spinal compression. He got better on Ponazuril, but today, on day 29 of meds, is leaning a little again.
I knew because his symptoms improved so much. He was having trouble finding things. Couldn’t find his stall, couldn’t find the water trough. It was like he developed a really severe case of dementia. He also dropped a lot of weight. 14 days after he started treatment he was back to his old self.
My vet has said that the problem, at least in my area, is every horse is going to test positive for EPM. Every horse is exposed to it, and you’re testing for antibodies. The horse only has symptoms from it (and actually gets an infection of it) when they are immune compromised and it gives it a chance to take hold. That immune compromise could be stress, it could be age, it could be another disease.
Thanks. He is old - 22. But very fit. He had no signs at all. Just a little off in the back. Then walking sideways after stifle flexion. I fear it is really a spinal issue.
One of mine was 22, the other 23 when they got it. None of the rest of the herd did.
The toltrazil is cheap enough (at least, significantly cheaper than X-rays and such) to try it and see if you have improvement.
Also, totally off topic of EPM, but one of my horses was rated as severely neurologic, do not ride, immediately PTS because he was so off balance after stifle flexions.
I got a second opinion who said ‘oh, his stifles hurt. Let’s do a round of adequan and see if we need to move to direct joint injections or not’.
That vet saved my horses’ life. It was indeed just stifle pain.
Thanks. Just what I have been thinking. I asked about trying Pentosan a while ago. Or Adequan. The vet just focused on hock xrays and EPM after severely positive stifle flex. Also looking for 2nd opinion. Honestly, a long, high, stifle flexion may just be too hard on these older horses. They also sold me some Rebalance - not easy. I did see that toltrazuril is easy, so may try that too.
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