What are some signs that your horse may have EPM. Is a mild case curable? What have you used to treat it?
My then-yearling was fine one day and started dragging his hind toes the next. Turning him in tight circles showed uncoordination, and he moved very oddly on inclines especially going downhill. My gut feeling was EPM, even though this was my first personal experience with it. Vet came out, did neuro exam and pulled blood which was sent to UC Davis. Titer numbers were extremely high. We did one month of Protazil then a month of compounded Ponazuril. He completely recovered but had a mild reoccurrence a month later. After another round of the compounded Ponazuril he was 100% recovered and has not had another relapse in more than three years.
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It really varies widely. For my 16-year-old gelding, who I sadly just had to put down, I believe he came to us already dealing with EPM, though the signs were so subtle at first that we attributed them to his background.
That first summer he was with us (age 14), he had some trouble picking up his feet for the trimmer, but we thought it was because he was a former carthorse crossbred, probably used to being shod in stocks and not used to lifting his feet “on his own.” He also tripped and fell on his knees once while cantering, but again, we chalked it up to being a former carthorse not used to cantering. He was super quiet and always tried his best, so I think he masked a lot of discomfort.
Things changed that first Fall after he had some routine vet work down. He had a major personality switch—started spooking at everything and even bolted once (completely out of character for a steady adult beginner horse - and with a sidewalker on that day). We tested for Lyme, treated for ulcers, etc. The vet was reluctant to test for EPM because he didn’t “look neuro,” but I insisted (b/c of the behavioral changes which can be neurological). The test came back high, and we treated him for a month.
He made a good “recovery”—could pick up his feet, canter/jump. But this past Fall, the signs returned. He started hesitating at the step down from the barn—he’d have to really “think about it.” I pulled him from the lesson string and treated him for six weeks. He was a bit spooky and reactive during treatments but seemed “okay” otherwise. Then, over the last month, his mobility and confidence worsened. He started mostly staying in his shelter, walking carefully in his paddock, and eventually bumping into fences and trees on the last day when I made the call to let him go.
For him, the signs were quite subtle at first—stiffness, slight tripping, behavioral changes—until they weren’t. A mild case can definitely be treatable, but in my gelding’s case, I think he had already been dealing with it for a long time by the time we caught it.
Good luck! 
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A LOT of things that present as “not quite right” can be symptoms of EPM. The full blown neuro symptoms are much more obvious.
When I had my guy worked up over front end knee buckling, he threw a moderate titer, so we treated 30 days with Marquis. Didnt do anything. At the time of the neuro workup, we did find changes in the cervical spine as well, and are attributing the tripping to that. That for now, is being successfully managed with Equioxx and electroacupuncture.
I personally know horses that have been treated with no more issues and know people that have had to put horses down due to EPM as well as many similar stories online.
What is your definition of a “mild” case? If it’s titer based, that’s not always the best indicator. Symptom based? What are the symptoms? Has those horse had a neurological workup from a vet?
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Thanks for your reply. When I would walk her our to the field to graze a bit, while I did chores, she would stop eating and stare into space… ( odd behavior for her). Then when I showed up, she pinned her ears and walked away from me. ( Odd behavior for her ). I got her back out to the field, Finally, all of a sudden she started spinning in a circle and backing up like she was stopping herself from falling. Vet came right out and did a nero workup on her. she did show resistance to tail pulls. But, had another episode of circling when the vet was there. Very stiff in hind end, vet said she should of been on Equinoxx all this time, and put her on Decoquinate/Levamisole. Big change in her attitude, she started eating normally again. Once I ran out of the meds, she went into depression. I just put her back on it for 6 more days… waiting to see how she does.
Ugh, sorry you’re going through all this. The dec/levamisole combo does seem to have some good success. There are a couple Facebook groups for EPM that I was really paying attention to going through everything last year if you have Facebook.
How long was she on the meds before you ran out? It seems like people treat longer term with that combo depending on the horse. Or will start another round if symptoms return.
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She was out about a week… so hoping this second round lasts longer… I do realize she is old and I don’t want her to suffer.
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How long was she on them total? It sounds like most people try at least a couple months to start?
yeah they need to stay on them for longer than that!
Mine relapsed with the initial treatment. We the did a second month long treatment with both drugs. That seemed to fix it. Her symptoms were hypersensitive to touch primarily on the left side and some not quite rightness with the right hind. The following year she had more sensitivity to touching it turned out that she had Lyme and Anaplasmosis. She got even better after that treatment. Then I put her on a liquid vitamin e that got her over the final hump. Pretty normal now but is still crabby about being saddled which I attribute to residual neuro sensitivity. But totally sound to ride
Agree with the others, she needs to be on the meds longer than a week. A horse here was treated with Decoquinate/Levamisole for a month or two, and then was on a regime of one week on the meds every month which kept the EPM at bay. He was 30 or 31 when he first presented with the EPM, and 32 when his owner decided he was too fragile for another winter.
How many ml of Liquid Vit E did you treat with?
6ml once a day for maintenance. I started out higher I think.
I use Nano-E
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Thank you, I have that and tried it… wow she hates it… this is going to be fun… said no one!
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JB, another poster, recommended Emcelle. She said it was cheaper and just as good. It might have a different flavor. Good luck
