Marquis vs Rebalance EPM

[Bloopie]

My 3yo began showing signs of EPM about 2 months ago when his left hind leg became weaker than his right and developed a more exaggerated rotation than his right. So to be clear, his left hind leg regressed. His titer came back as 1:2000 so vet recommended Rebalance which we did for 6 weeks per vet. He got a little better and that leg is more stable but I’m worried he needs more treatment even though vet said we could stop. His trainer thinks he’s improved but I was long lining him and the difference in musculature is still apparent left vs right hind.

My biggest issue with Rebalance was my vet saying no food 1 hour before and after dosing. I board him but don’t trust the staff with something as serious as this (and for reason if you subscribe to the belief past behavior is the best indicator of future behavior). However, I simply cannot keep going back and forth to the barn as I work full time.

My schedule looks like this while on Rebalance although times are approximate. Note there is no WiFi at the barn and my cell service is too poor to hotspot:

8AM (earliest boarders can be at barn): Arrive at barn, catch him from pasture and put in stall. Feed barn cats because why not. Check no hay leftover from prior dinner. Set timer for 1 hour

8:20: Arrive at home. Feed my cats, log on and try to do some work.

9:30: Arrive at barn to medicate. Set timer for 1 hour.

9:45: Back at home for meetings/work

10:50: Arrive at barn to feed hay + grain + vitamin E supplement. Very hungry boy.

11:15: Arrive at home to work.

I did this for 6 weeks and people start pinging me around 8:30. I’m an accountant so I need the internet to access all of my files, etc. I tried setting up an arrangement where I could not attend meetings before 12 but my boss kept forgetting and the CFO doesn’t check calendars so blocking off time just wasn’t working.

Would Marquis be something worth looking into? I just can’t maintain this schedule with my work responsibilities. It may not look like much, but it is extremely disruptive. And that’s even if he still needs treatment…our area is flat, flat, flat so no hillwork and I’ve tried stressing to his trainer, whom I adore, to add more pole work in his routine. I’ve also considered getting an Equiband. He’s three so he only works under saddle 2x per week and sometimes I’ll long line so maybe 3x per week of work. I just need that left leg to catch back up to his right

[jherold]

I’ve used lavamasol and oragen from Pathogenes to successfully treat epm. It’s just pills and no fasting needed. As I recall, i cut them in half and stuffed them in carrots. Tons cheaper than marquis and works better. As I understand, Marquis only treats one variety of the protazoen and the lavamasol oragen combo treats 3.

[Critter]

I used Protazil which are pellets and go in the feed once a day. My guy ate them right up and had a good recovery with that med. It’s no difference in price than Marquis and know to be just as effective.

Recently he showed signs of a flare (after an Exceed shot for cellulitis, which he always has a bad reaction to)…I am finishing the Protazil I have and then switching to the Farm Vet ponazuril powder, which is more affordable, but still has good reviews. It also goes in the feed with a bit of corn oil.

[JB]

Go with compounded levamisole/decoquinate. Cheap (relatively speaking), excellent results for a lot of horses.

It’s what’s in Orogin from Pathogenes, just cheaper since Orogin isn’t approved yet (I heard they were working on FDA approval)

[anonevent]

I use Protazil as well. One scoop a day mixed in his feed.

[FjordBCRF]

I put this together when starting on our EPM journey this month. In addition to a 1:2000 titer, we also found a mineralization deposit between the skull and C1 and degenerative changes at C5, C6, and C7. His ONLY symptom for EPM is front end stumbling which could also be attributed to his neck findings. I started with Marquis because of the safety profile and it was easy to do boarding. The cost gave me a good excuse to finally try and sell all the crap I have accumulated that I don’t use and has been taking up space for far too long LOL.

I pulled this together to help get my head wrapped around everything:

1. Protazil (Diclazuril)

• Targets : Sarcocystis neurona by inhibiting the protozoa’s ability to reproduce and spread within the nervous system.
• Safety Profile : Safest option, minimal side effects (rare gastrointestinal upset).
• Cost : Moderately expensive.
• Ease of Administration : Easy—pellet top-dressed on feed.

2. Marquis (Ponazuril)

• Targets : Sarcocystis neurona by disrupting the protozoa’s energy production, which inhibits its reproduction.
• Safety Profile : Generally safe; possible mild gastrointestinal upset or neurological symptoms.
• Cost : Expensive.
• Ease of Administration : Paste form, daily dosing.

3. Rebalance (Sulfadiazine/Pyrimethamine)

• Targets : Sarcocystis neurona and Neospora hughesi by interfering with folic acid metabolism, preventing the protozoa from multiplying.
• Safety Profile : Moderate risk; potential for anemia and gastrointestinal issues, requires blood monitoring.
• Cost : Least expensive.
• Ease of Administration : Oral liquid, requires daily dosing.

4. Levamisole/Decoquinate (Compounded)

• Targets : Sarcocystis neurona by stopping protozoa’s energy production (decoquinate) and boosting the immune response (levamisole).
• Safety Profile : Riskier; immune suppression, gastrointestinal, and neurological side effects.
• Cost : Moderate.
• Ease of Administration : Powder mixed with feed, 10-day course.

Today will be day 16 with Marquis and I have not noticed any changes so far.

[mmeqcenter]

@Bloopie

His trainer thinks he’s improved but I was long lining him and the difference in musculature is still apparent left vs right hind.

Well, it’s going to take some time for the musculature to even back out, six weeks isn’t enough time to build muscle in general when working only 2-3x per week, much less when battling something like EPM.

But when I used Rebalance, I ended up going 180 days (six months) for my mare. When I first tried to wean off, she “relapsed” a bit so I extended her treatment. I also continued the vitamin E for at least a year, which helped immensely.

Is your vitamin E supplement a water-soluble vitamin E? That is imperative.

What time does your barn feed in the mornings? Do they get hay outside overnight or just grass? How much grass do they have? If you’re the first person at the barn at 8am and bringing him in, and it’s light grass they just pick through, it’s probably fine to just give him the Rebalance at 8am when you bring him in, if the barn doesn’t feed until 9am or so.

As far as your CFO "not checking calendars - that’s rude. Personally, I decline meeting invites that are sent for a time I blocked out on my calendar. IDC who it’s from, frankly. We have shared calendars for a reason. So I guess my suggestion here would be, decline meetings when you’re marked as unavailable.

[mmeqcenter]

Interesting, thanks for this, nice to see them side-by-side.
I will absolutely admit, I chose Rebalance largely due to cost (I did research them all). I’m thankful that it did the trick and I didn’t have to try another medication. I’ve known people go through all four before finding the one that worked for their horse. Also, my mare is pretty picky with supplements so I wasn’t interested in spending money on a pellet or powder that she likely wouldn’t eat.

I didn’t do any blood monitoring on Rebalance and my vet never mentioned it as needed nor recommended.
I saw improvement within the first week.
I did keep my girl on ranitidine during the course of treatment because she has a history of recurrent ulcers.

[Simkie]

I’ve had great results with the compounded ponazuril, and it’s just dead cheap. I source it here:

https://www.farmvet.com/Ponazuril-Powder?location=&quantity=1&compound-strength=49&compound-size=19

I give it with oil, per this paper:

Effects of coadministration of corn oil and ponazuril on serum and...

I have a couple that will just eat the powder & oil with their grain, but mix up a paste for others.

[sparkygrace]

This is the same protocol I followed. My horse also showed weakness in the left hind, but went undiagnosed for too long. (My vet just didn’t see it.) After giving him Protazil to get his numbers way down, I switched to compounded ponazuril, twice a week. So far, he’s doing great with no signs of EPM.

When I started treating him with Protazil, I also added Emcelle. Recently, I switched to Elevate and it seems to work fine.

[FjordBCRF]

One of the other things I started doing as support in addition to the increased Vitamin E was adding in a colostrum supplement. I actually started taking colostrum myself in February of this year due to my own autoimmune issues, and I find it really helps me feel better when I take it regularly.

It helps the immune system by providing high levels of antibodies that protect against infections and support immune development. It also contains growth factors, cytokines, and nutrients that strengthen and regulate the immune system, making it especially crucial for newborns. I have seen it recommended on a couple EPM Facebook groups and figured it was definitely worth a shot to help keep his immune system in good of shape as it can be.

[athelas]

Currently treating a particularly rough EPM flare with 4 doses of toltrazaril paste and then starting 60 days of levamisole after the 3rd tube. Seem to be getting decent results so far. This flare had the highest # yet so we’re throwing an aggresive treatment at it.

I previously treated last December with Orogin to good results, though!

[Simkie]

@athelas

then starting 60 days of levamisole

60 days? All in a row? Aren’t you worried about the immune suppression effects?

You might consider two weeks, then the first week of every month of further treatment, as described here:

Equine Protozoal Myeloencephalitis: An Updated Consensus Statement with a...

“The drugs used include levamisole (1 mg/kg PO q12h for the first 2 weeks of antiprotozoal treatment and for the first week of each month thereafter)”

[athelas]

Just following my vet’s advice. This is the third time we’ve had to treat. This spring was 10 days of levamisole.

[FjordBCRF]

I have a friend who is using levamisole as therapy for lingering polyneuritis after the EPM was cleared. The mare has been on it for many months and Im not sure if its meant to be long or short term in that case.

[Pepsy]

Hi,
Can anybody describe to me what lingering symptoms of polyneuritis you are treating? I ask because I am involved in a very frustrating case.
Thank you

[Zenyatta]

I used this protocol on my horse who had a severe case of EPM. I started seeing results within 3 days, Pathogens protocol worked wonders for my horse., after the full treatment my horse was fine.I highly recommend this treatment for EPM

[jherold]

Hypersensitivity to light touch. Normal currying was impossible. I could use one of those old fashioned metal curry combs as long as I went with the hair. Putting a saddle pad on made my mare very irritable. Th Pathogenes treatment was repeated and we dosed her for twice as long. Initially they recommed just extra time on lavamasol, but just lavamasol wasn’t enough for my mare so we did the full treatment for 6 or 8 weeks.

She exhibited similar symptoms this year and was diagnosed with Lyme and Anaplasmosis. So you might want to test for that as well. The liquid vitamin e was also a game changer to her hypersensitivity to touch.

[Pepsy]

Thank you. Horse has undergone Pathogenes treatment. Horse is negative to Lyme. Reading about anaplasmosis. New vet appt tomorrow

[jherold]

My vets’ practice had another mare that tried to savage you if you lightly touched her neck but was fine if you touched her firmly. She was positive for anaplasmosis. My vet tech is also my friend and based on this other mare we tested my mare. My mare wasn’t nearly as aggressive. We were all pretty shocked when she cam back positive for both. A week if antibiotics and her behavior improved dramatically. We are thinking of testing her again this winter to nip any relapse.