EPM-what's the latest in testing/treatment/prognosis?

[JustJump]

An internet search has produced all sorts of garbage…

For those of you who actually have one that’s been diagnosed, how was it tested for? How was the diagnosis made?

Are horses still being treated without a diagnosis? How is success measured?

Someone asked me, and it occurred to me that I only know of this disease second hand–I’ve never encountered it. For those of you who have, please describe what led you to seek a vet opinion, and what did the vet subsequently do about it?

I used to hear of many being given Marquis; is there anything newer now?

What’s the outlook for a horse diagnosed with it now?

[Meadow36]

There is no definitive test for EPM; even post-mortem it can be difficult to find. A large number of horses carry antibodies to EPM even if they are not clinically ill; so it can be difficult to assess the results of the tests.

The latest test that we are using at UF is an ELISA test developed at the University of Kentucky, that compares antibodies in the serum vs. the CSF fluid and comes up with a ratio. It is based on the response of the horse’s immune system to the immunogenic proteins on the surface of the protozoa, SAG 2,3,4. Apparently all of the ‘subtypes’ of protozoa have these proteins; while only 50% carry SAG 1 and a separate 50% carry SAG 5. Avoid tests that only look for SAG 1 or SAG 5 for this reason. By taking a ratio of the serum vs. the CSF, it can be determined if the antibody levels are high enough to indicate clinical disease.

Here’s the only link I can really find for it: http://www.equinews.com/article/epm-diagnostic-test-developed-for-horses

There is also the IFAT from UC Davis: http://www.vetmed.ucdavis.edu/ceh/docs/horsereport/pubs-HR27-2-bkm.sec.pdf

IIRC the issue with this one is that you can get immunofluorescence to subtypes that do not cause disease; therefore there is a high rate of false positives.

Marquis is still the gold standard in treatment; there are other options, such as diclazuril or sulfadiazine-pyrimethamine, but each treatment has its pros and cons.

Prognosis: it depends on the horse. The ones that do best are caught early and treated quickly. Those that have been lingering for months or years without treatment do not do as well. Either group can relapse with no warning.

[mroades]

my vet said they have just come out with a new treatment that is better than ponazuril/diclazuril and is significantly cheaper at 250.00 or so a month

Will know more monday after our appointment with him, and will update here

[M_O_Connor]

http://www.thehorse.com/Video.aspx?vID=425

[Meadow36]

I thought the “new” treatment was diclazuril, trade name Protazil; but if you find out something different I’d love to hear about it!

[mroades]

we have been using diclazuril for years…this is something new. The “new” diclazuril is just finally available on label

[Meadow36]

Right now I am using the PYR-SULF combo with pretty good results; of course I’d prefer something without the potential side effects. The one big benefit is it only costs me $60/month. I also give Zylexis injections for immunomodulation and 10,000 IU of natural vitamin E. The horse is looking much better, but not symptom free yet. It’s only been about 10 days or so into the treatment.

I wonder if the drug is Oroquin-10? This is a medication that is in clinical field trials. It is levamisole combined with a poultry coccidial agent. I did try this medication, and saw decent improvement; but then the horse seemed to relapse 2 weeks after finishing the course of meds (its a 10 day course). I had the option to put him on a powdered version of the same medication, but I decided to try the PYR-SULF combo first and see how he does.

[horserider12]

Yes it is oroquin. speak to dr ellyson in florida, you can google her. she is testing a med. you only give it for 10 days and it cost 100 dollars. It seems the protozoa that causes epm has 3 phenotypes, marquis only treats one of them. She has a simple blood test that she will do at her lab the same day it is received and it tells you which phenotype it is. I know of one horse that showed no results on the marquis and was going to be euthanized, he started on this med 2 weeks ago and is now cantering around the paddock when he couldn’t even walk without falling down before. It is not fda approved, but is approved for malaria in humans so relatively safe for horses. I can’t tell you about relapses as it hasn’t been that long.

[bthatasitmay]

I have a friend who just went through all the EPM testing and humming and hawing. One vet just wanted her to treat her horse w/o testing and it was also recommended by a chiropractor to do the same. She did have him tested and was considered negative. I know, it is not accurate, but she also had him tested for Cushings and he showed a slight positive there. He is now on pergiloid and has improved considerably to the point where she is riding again. The horse is 12 yrs old. I don’t have all the details. I have personal experience w/ Cushings (2 horses) and they did not show the symptoms my friend’s horse had. Her horse had odd lameness issues.

[eventrider]

We treated with Baycox via stomach tube and have been so far so good. No relapses and horse is now running intermediate eventing.

[Tommyknockers]

Funny this should just come up. I have 4 diagnosed with epm and a friend has 7. Thousands and thousands of dollars were spent on all kinds of diagnostics for vague hind limb lameness, back soreness,etc. I highly recommend you contact Dr. Ellison. I had two horses whose titers were off the charts on the elisa test but tested neg. several times with the western blot test and one of them also had a spinal tap which was also negative. They were all treated and recovered. One mare had a mixed infection (there are several strains come to find out) so she did not respond to the Marqui. She responded to the sulpha drug. The symptoms my horses exhibited were not wanting to pick up the right lead suddenly(2), one with a very sore back, one mare would eat with her head sideways even after having her teeth done by a dental vet specialist and re-checked several times,and the other mare was tripping. After treating for 2 weeks all of these signs dissipated or got gradually better. The more people know about this the better. I believe epm is more prevalent then the vets are willing to acknowledge and a lot of the vets are VERY closed minded about anything new coming out. We just had one of the horses to the clinic for a neck xray to rule out wobblers (neg) and the vet who owns the practise spoke very highly of Dr. Ellison and what she is trying to do help horses and their owners with this disease. No one else is that is for sure. Marqui is NOT the be all and end all, they just have fantastic marketing. FYI the friend who had the 7 horses with epm spent over 17 grand on diagnostics. I also spent thousands on chiro on my gelding. It would bring him some relief for 2-3 days but then right back to square one. Dble dose of adequan did him wonders for 3 days but that was just because it took the inflammation away being caused by the protozoa.

[Tommyknockers]

http://www.pathogenes.com/about_us. Dr. Ellison’s website.

[eventrider]

I also think that many more horses have this than are diagnosed. Dr. Nancy Buonpane on Long Island is also on top of this disease and really knows her stuff. My horse had chronic ulcers that is not respond to months of turnout andGastroguard, as well as right hind issues. Locking stifle, 4 beat canter on right lead, etc. I hope more horses are diagnosed properly before they get bad. I believe my horse had it for years before Dr. Buonpane came along…
Other vet thought it was SI issue. We injected the SI and horse had a horrible reaction…couldnt move,shaking,fever. Turns out steroids can cause a flair up of EPM. This was prior to the EPM diagnosis. Poor horse!!! And we injected huge amounts of steriods right into the SI. It is a funny disease to diagnose.

[Meadow36]

I wish I had as much luck as you did with the Oroquin. Unfortunately the horse relapsed two weeks after finishing the course of treatment.

[Tommyknockers]

There is some thought that some of the protozoa is hiding in cysts hence they are not all being killed during treatment and that is why you are seeing relapses. That is how I understood it.

[mroades]

So yes, my vet was talking about Oroquin. I hope it works for our guy.
PS< I also had one walk talk and quack like EPM, and it was Cushings.

[Meadow36]

Good luck I hope it works!! Post an update after the treatment is done.

[winstonian]

I’ve found this thread very interesting. My horse has been dealing with EPM for 9 years now. He’s gone through treatments of Marquis, sulfas, and several courses of Navigator (nitazoxinide, now off the market). He’s had several relapses, and the only thing that seems to keep the disease in check is the sulfadiazine-pyrimethamine combination. Whenever I’ve taken him off them, he’s relapsed shortly thereafter. On my vet’s recommendation, I’m planning on keeping him on them indefinitely unless a new treatment comes along that might permanently address the issue. I’m eager to look into the experimental drug that some of you have mentioned.

On the bright side, I thought I should add that my horse, who is 13 now, is doing great. We compete in the AA jumpers. Even though it’s a level well below his pre-EPM potential, I’m so happy that he’s thriving.

[Bank_of_Dad]

No info here, but I lost the love of my life to this %%$$## disease. Better luck to all.

[Perfect_Pony]

While my horse did not suffer from EPM but EDM, Vitamin E is a very important part of preventing and treating both diseases.

All horses not on green pasture should be supplemented 2000+IUs as a prevention. Diagnosed horses should be supplemented 5000+IUs daily.