Greetings to all…new to the group. My girl was just diagnosed with epm on 10/17. Grade 2,pushing 3 on the Mayhew scale. Kicker…we were just at a show in Syracuse where she was Circuit Champion in the HUS. When we got home, she seemed body sore. She does see a chiro occasionally so we assumed she needed adjusting. Couldn’t get an appointment right away so just lightly worked her. 2 weeks later, came to the barn in the am and was greeted with a head tilt and nose askew. Again, thought maybe pinched nerve in her neck, was still moving ok. Started her on some Robaxin. Next day, ataxia noticed. I immediately took her to New Bolton Center. They did bloodwork which showed her at 1:2000. Wanted to do a spinal tap but she was too unsteady. Did xray her neck to rule out wobblers. She was started on Marquis and Re-Balance immediately. Saw improvement the next day and everyday after. After day 7 she was stable enough to do the spinal tap which came back positive. I was able to take her back to trainers barn on day 9, last Thursday. So now we are hand walking her and giving her her meds. She seems to be improving a bit everyday. Still a little gumby in her body, head tilt and nose are back to normal. She does resist when you pull on her tail in both directions and will readily back up. I have to take her back in 2 1/2 weeks for re-evaluation and to determine if she needs to be on the meds longer. I want her on them longer just to make sure.
I did start her on 10,000 iu of vit e. She gets no turnout so I am sure she is probably deficient. They did test for it but I have not gotten results back yet.
Sorry to ramble but this is completely overwhelming me. Any feedback would be greatly appreciated.
Way to be proactive and notice small changes in your horse! It sounds like you caught it very early and she’s responding positively to treatment. Prayers for a recovery that enables you to climb back on her again.
Only feedback I can give, is to allow her to have some turnout time while she’s being treated a recovering. This could help decrease muscle loss. If your trainer’s barn does not do turnout at all, can she go out in a small paddock or arena for the hour that the trainer would otherwise be riding her? (In lieu of a ride she gets some turnout time).
Make sure your vit E is natural not synthetic - it metabolizes differently. Expect a treatment crisis in about a month - the symptoms may reappear as the protozoa die off and cause swelling in spinal cord.
Thank you…I am being cautiously optimistic. The vets at New Bolton asked that I not turn her out yet. They want to recheck her first. I have been handwalking, large circles and backing her a few steps. She does resist in both directions when you pull on her tail, just a little gumby in her body.
Yes to the natural vit E. I have been reading WAY too much about EPM the last 10 days and saw many posts about using the natural as opposed to the synthetic. Are there any other supplements that would be recommended to boost her immune system?
The vet at NB did tell me about the die off. Not looking forward to possibly seeing that !!
Read the Pathogenes.com website and watch their videos. It will help you be more aware of signs of EPM and EPM relapse. My guy was diagnosed with EPM 1 1/2 years ago. We treated with Orogin, then Neuroquel, then Protazil. He has been fine since a few days after starting the Orogin, but his titers were so high that the vets wanted him on a series of meds.
Horses can go back to normal after EPM. It sounds like you figured out the diagnosis quickly. Hopefully, everything will soon be back to normal.
Catching it early and treating it aggressively seems to be key to a good prognosis. My guy was dx with EPM in early September, also with a 2/5 on the Mayhew scale. Four weeks into Marquis treatment, he’s non neurological and we were even given the go ahead to begin light work under saddle! He’s weak in the hind end so we’re working on lots of walk/trot over ground poles and over hills to re-build his muscles.
Vet recommended Vit E as well as Transfer Factor - it’s supposedly an immune booster but she was the first to admit there wasn’t a lot of clinical data behind its claims. Still, it was an option and she didn’t think it would hurt. I did notice that his rain rot cleared up after a day or two so I’m going to count that just as a bonus!
Edited to add: Vet also warned me that they often get worse before they get better as the protozoa die off…DMSO is an option if that becomes an issue. You will likely become BFFs with your vet team over the next few weeks since they tend to check in daily to see how everyone is feeling over the course of treatment.
Thank you everyone for your comments so far. Today seemed to be a bit of a backward step to me. Allie got her feet done on Monday (pulled hind shoes since she isn’t going anywhere for a while, pulling her fronts are not an option as she has issues with her Palmer Angle so I don’t want to mess with what is working.)
Today we walked in the indoor. She walks pretty readily and was tracking up better but seemed a bit sore up front. No toe dragging, still a bit of tite roping behind. She just did not seem as bright as she did Tues when I was there. (barn is an hour away so I am going every other day and trainer is walking her on days I am not) Occasionally I would stop to back her a few steps and give her a break but then she would not want to go forward again. With some coaxing she did but was a bit more stubborn about it than usual. Once she got going she was good. In her stall, she nickered to me but just stood in one spot for the most part.
I may just being looking too hard. I want my girl back !! 
I wonder if it is the die off starting to show up.
Watch out for laminitis. A die off of parasites pours toxins into the bloodstream and that will affect her metabolically. If she’s reluctant to move the following day, you might want to have the health of her feet looked at by your vet. Or at least call your vet and ask for their opinion.
I have an EPM survivor who is going on 16. Diagnosed at 6. Still happy, still being ridden, still has side affects from the disease.
I had better luck with Orogin instead of Marquis - fewer side effects. It was hard to get. My horse was very, very subtle and came back with a similar titer but none of those symptoms. The only thing that even caused us to test him was a bad shoeing job and he started to trip.
He is doing great now. Since he was never ataxic, he stayed in work after the first week of treatment. He did not have a die off relapse, but I did vit e and DMSO from the outset.
You seem very competent, so don’t take this wrong, but has her grain been cut since she’s basically just standing up now?
Also, as soon as she’s cleared, I’d start turning her out some (more is better). Horses just aren’t wired to live in a stall 23 hours a day.
Lastly, when thinking about long term management, I’ve known horses that relapse when vaccinated. I always proactively treated my EPM guy with Marquis whenever he got shots.
Note that the spinal tap is the least desirable option for testing, as even 1 RBC can skew the results to positive, and there’s no differentiating between exposure and active infection.
www.epmhorse.org talks about the different tests and which are preferred and why. You want to know THE protozoa which cause EPM, and that there’s active infection vs just exposure.
You can use synthetic E, you just need about 30% more to be as effective as natural E. 10,000IU is the standard therapeutic dose for a recovering EPM horse, and for life she may need to be on 5000-8000IU/day. So while she may well have been low due to prolonged periods of no grass, it wasn’t a factor in that 10,000IU dose 
Not taking anything wrong at all. I appreciate all comments !!
Yes, we cut her grain in half. She has an appointment at New Bolton on 11/14. I also asked if she could see the neurologist, Dr Amy Johnson in addition to the vet that saw her initially. Dr Johnson was out while Allie was there but I did email her and she was very kind to reply to me. I don’t want to step on the initial vets toes at all but I am more than willing to pay as many vets as it takes to try to give Allie the best chance at coming back.
I am hopeful that she will be able to have some turnout after that date. I read about the vaccinations. Did you just give him 1 tube of Marquis when you vaccinated or a months worth? Also read about worming…any comments regarding that? My trainer generally wormed about 3 times a year.
I plan to talk to Dr Johnson at New Bolton about the spinal tap results. All they told me was that they were positive. Is there a positive/negative range or is it simply that they found protozoa in the spinal fluid? I emailed the vet that treated her (emergency medicine vet) and she has not gotten back to me.
The report just says " SAG2, 4/3 ELISA positive at 1:2000. Lumbosacral tap was safely and successfully performed. Cytology analysis of the fluid obtained was within the normal reference range. A ratio of the antibody levels between serum and CSF sample was obtained with a result in the range that is definitive for EPM"
Check the link - all the details for the different tests are there
In general, the risk of a false positive with even the smallest red blood cell contamination is high.
In general, you want the SAG1,5,6 , so either the Peptide SAG ELISA or, preferably, the Multiplex Sn Antibody test. Testing for 2,3,4 can give false positives
So…weekend update. Allie has had a great weekend IMO. She was much brighter yesterday and actually grabbed her hiney a little in the indoor. There were 2 horses working and in the past couple of weeks, she has not reacted at all to other horses being ridden around her. She was very forward and tracking over at the walk. We did a couple of tight-ish circles in both directions and backed a few times.
Today, we were alone in the indoor. She again was very forward walking and shook her head and grabbed her hiney again. After walking (serpentines, big circles and backing) I did ask for a couple of jog steps. She willingly did and all I really saw was her short striding in her left hind. That being said, she was doing that before all this ataxia stuff started. She is past due to have her hocks and stifles injected. In the past, injections have lasted 6-8 months. She is at 10 months right now. Hoping this is all positive.
Glad your horse is feeling better.
So, today I lunged…and I am very happy to say Allie looked great !!!
Tuesday I was walking her and she was just beside herself full of it. I decided that if she was still looking that good today, I would try her on the lunge line. I saddled her and put side reins on her to try to keep all 4 on the ground the best we could. We started out hand walking around the arena. She was tracking over at least 6" on both hinds. So I slowly let her out. Of course she bronced about a little and then settled into a very forward trot. We walked, trotted and cantered in both directions…no slipping, no falling. Still noticing a slightly shorter stride on the left hind. I stopped after about 10 minutes, did not want to push it. Afterwards I did notice that she was resting her left hind, occasionally shifting and resting the right hind.
Tomorrow will just be hand walking but I really think she needed that release today. I would love to be able to just turn her loose but the indoor is just too big. I know she will get her steam up and slide and spin.
Back to New Bolton for re-evaluation Tuesday.
