Neurological Issue? Need Help. Gelding with strange behavior that no one has seen

[wanderlust]

@TXKing99

She definitely isn’t saying there is no physical issue - she has suggested I test for EPM. I have been hesitant to do that because he isn’t presenting in typical symptoms. That’s what led me to post in an EPM FB group - I wanted to see if anyone had seen his behavior in a case of EPM.

EPM is a quick easy blood test. Want to say it’s about $200. I’ve heard stories of EPM manifesting in many odd ways including urination issues in geldings. I know you don’t want to throw good money after bad at this point, but do think it’s worth ruling out before throwing in the towel.

I’m sorry you are going through this - I just lost a 5yo gelding to suspicion of EDM, awaiting the final necropsy results and it is so sad, frustrating and heartbreaking to be dealing with these kinds of difficult-to-diagnose issues. Big hugs.

[NaturallyHappy]

I second this…a veterinarian I think well of always says “ EPM can present any way it wants to”. I think he may have attributed that statement to Dr. Reed. I think the blood test can sometimes be unreliable. You could potentially treat anyway. Just options…

[Ghazzu]

@wanderlust

EPM is a quick easy blood test.

If I were the OP, I 'd be inclined to go for a CSF tap vs. bloodwork at this point-- a CSF tap would potentially provide more information than EPM positive/negative, and is more accurate any road.

[vxf111]

Agree. I think in the grand scheme of things its a logical next step.

[TXKing99]

My vet prefers to do the CSF tap for the very reason you mentioned. I actually assisted him with a CSF on another horse in our barn with very obvious signs of EPM and it came back positive.

Honestly, I am hesitant to do the CSF after watching one, though I know it provides more info and more accurate results. Not ruling it out though.

Any thoughts on the blood test and having it sent to UC Davis? I know someone who did that and the results seemed to show a lot of detail. Her horse came back with a 76% chance positive and she is treating him with compounded toltrazuril with DMSO.

What are the risks of just treating him for EPM?

[IPEsq]

With the blood test it depends. I tested one of mine who had a very low chance of an inconclusive result based on where he lived his entire life to that point. But my vet said if it was borderline, we’d treat. It was an extremely low titer, so we explored other more likely problems and did not do a spinal tap.

I think it would be good to have baseline numbers before treating, personally. The treatment also is kind of pricey if you do Marquis, so in the interest of budget I’d do one of the tests first.

[vxf111]

The problem with the blood test is that if you live in a place with lots of exposure, every horse is going to come back positive. And if the horse is positive, the only way to cure the EPM is to treat. So that means pretty much every test is going to result in you feeling like treating. So you might as well just do the Marquis and not even test if that’s the case. If you live in an area where EPM isn’t rampant, then it might make sense to do the bloodwork. But a lot of places in the country it’s just not all that helpful in terms of the information it gives you.

[Peggy]

For EPM, I listened to the podcast version of this blog and found it pretty helpful. There’s a link to the podcast in the article so you should be able to find that as well.

EPM, and Why Your Horse Probably Doesn't Have It - Springhill Equine...

It reiterates what people are saying upthread about the futility of testing asymptomatic horses in certain areas.

There are people who really believe in what’s on the Pathogenes website. Others not so much.

I live in an area where it’s endemic and it’s fascinating to see how EPM seems to be diagnosed more in some vet practices than in others. Twenty or more years ago in a small geographical area serviced by 3-4 vets who tended to stay in the area probably >95% of the diagnosed cases were in one practice. While I believe it’s definitely a thing I do have some skepticism.

[No1]

I think Ghazzu’s pointing out that, if you do a CSF tap to test for EPM, you can also test the fluid for other things while you’re in there. Cancerous cells for one thing.

Doing the spinal tap would not only give you a definitive answer on EPM, it could also provide other valuable diagnostic information and get you the most ‘bang for your buck.’

[Ghazzu]

@No1

I think Ghazzu’s pointing out that, if you do a CSF tap to test for EPM, you can also test the fluid for other things while you’re in there.

Just so.

[Martina]

Something similar happened with my gelding recently. No squirting. I pulled him from his stall and put him on the cross ties. He then spontaneously tucked his pelvis and it looked like he had an erection. The whole thing looked like he was mounting a mare but without the mare Afterward, and it only lasted a couple seconds, he looked at me and appeared really surprised. I felt bad for him!

The only observation leading up to this was that in previous days when I brought him out to groom, he dropped and it looked like his penis was swollen. The first time it happened I reached for it to check it out and it turned into an erection so decided I wasn’t going to participate in that. This was going on during the final shedding season. I attributed it to being itchy and needing a sheath cleaning. But IDK.

[TXKing99]

@TXKing99

Have been reading more about polyneuritis equi since it was brought up in the discussionand found this:
“Polyneuritis equi is a condition characterized by paresis of the tail, bladder, rectum, and the anal and urethral sphincters. Paresis or paralysis is accompanied by analgesia over the perineal region. Muscle wasting and an uneven gait can be seen. Cranial nerves can be involved. You will see a drooping lip or ears, inability to blink and wasting of chewing muscles. The experimental cases showed hypersensitivity in the skin over the neck and body, behavior changes, changes in vocalization, weakness, and chewing disorders.”
This made me think of a couple of things about him and I didn’t mention that might be related:

1. Jasper was very head shy when I first got him. He is much, much better now. But almost always looks away when I got to touch him on his face.
2. Back when I was riding him, he would spook at muck fork lines in the arena, or ground poles. One day he would go over them, and the next it would be like he had never seen them before and be spooked. I really wondered if he had problems seeing, those his eyes were checking during his PPE.
3. I never thought he was hypersensitive to touch, but when being groomed he moves around a lot.
4. He drops his food when he chews. He had his teeth done last September, but has continued to drop food.

I wonder if these could be related to Polyneuritis equi?

Quick update everyone. I edited the post yesterday to include more info for those who are following this post.
I reached out to the author of the article " Polyneuritis equi…it is not EPM," Dr. Siobhan Ellison via email and they responded suggesting I send them a blood sample to look at SAGs and CRP to start and suggested Jasper may have a non-demyelating polyneuropathy.

I will be reaching out to Rood & Riddle and New Bolton Center as well.

[joiedevie99]

@vxf111

The problem with the blood test is that if you live in a place with lots of exposure, every horse is going to come back positive.

We haven’t had this issue. We’ve been doing the blood test yearly for a while now and it’s been super reliable. Consistent low titers for most horses - with the occasional spike up to 1:2000+ that we treat/re-test at 3 months.

I see why it makes sense to do a CSF here (to test for other things as well), but based on my experience I would not do a CSF for EPM.

OP - Marquis is a very safe drug. The major downside to the ‘just treat’ approach is cost.

[vxf111]

On the flip side, here in the mid-atlantic I have never seen a horse come back negative or so conclusively low that it ruled out EPM. Even in horses that necropsy later revealed a different explanation for their condition. So I think it really depends. I don’t know the situation well in Texas.

[vxf111]

Please keep updating if you don’t mind, this is a very interesting case.

[starsandsun]

Is there any medication that would be reasonable to try, while you’re waiting for a diagnosis? For polyneuritis equi, can they treat with anti-inflammatories? Steroids? Anything to help him be more comfortable?

[Tha_Ridge]

@vxf111

On the flip side, here in the mid-atlantic I have never seen a horse come back negative or so conclusively low that it ruled out EPM. Even in horses that necropsy later revealed a different explanation for their condition. So I think it really depends. I don’t know the situation well in Texas.

Texas is EPM central, or at least was when I had horses there. We would always just treat.

[mfglickman]

If you have other horses on the property with EPM I’d do the blood test at least to rule it out. I don’t think the treatment will hurt if the titer is high and you don’t have any other explanation for the symptoms. Marquis will run about $1200 for a month and we treated both my horses for 60 days (gulp). There are other treatments though, including a compounded version of the Marquis that I believe folks have found for around $300. Just make sure whatever treatment you decide on is an approved anti Protozoal and not just one of the herbal “super remedies” some folks recommend (I’ve no problem if someone wants to try these after killing the Protozoa but it breaks my heart to see desperate people preyed upon by someone trying to sell a bucket of herbs in an MLM scheme…)

Both of my mares had subtle symptoms, it took a while to diagnose the first one, and longer than it should for me to recognize the second, given that I had just gone through it, but her symptoms were very different from the first. So it is a strange disease and presents in many ways…but I’m glad you’ve posted here and gotten some other avenues to consider in case it’s not EPM, or not only EPM. I’d love to think a teaching hospital would be very interested in helping you out…

Good luck and all good thoughts for you and Jasper!

[2tempe]

OP - my horse was not sensitive to touch, rather he actually lost sensation from his cranial area eventually partway down his neck, also on the one side of his face. Re the vision: you can easily do a “menace” test to see how he responds. https://www.youtube.com/watch?v=kBDC59pbSZ0
Edited to add: this horse was imported from non-EPM country so we pretty much ruled that out at the start. You have a different situation, so that complicates things for sure.

[IPEsq]

I just read a sad story about a lease gone wrong with a horse that was 3/5 neuro which started with urine dribbling and the horse being unable to normally empty his bladder. They did a spinal tap and found it was some unusual other infection not at all common in equines.