Dr. Gray, if a horse is treated for a mild case of EPM, and the treatment is “successful”, can the horse make a full recovery or will it always be in their systems to where a possible recurrence could happen in the future. Thank you M.L.S.
Dear M.L.S.,
Equine Protozoal Myeloencephalitis (EPM) is a serious and potentially fatal neurologic disease of horses. It is also a disease near and dear to my heart, as two horses that I owned both developed it. My thoroughbred was treated, made a near 100% recovery, and hasn’t had a single relapse. My quarter horse/app was treated, did not quite recover his ability to canter, and relapsed so many times I lost count. So your question—full recovery or possible recurrence—is a good one.
According to Dr. Stephen Reed formerly of The Ohio State University College of Veterinary Medicine, the prognosis for horses with EPM seems to be similar regardless of the treatment used: 60 – 75% of horses improve on standard therapy. Unfortunately, less than 25% of affected horses return to their original function. While a number of medications have come on and off the market—and many continue to use the combination of trimethoprim/sulfa—there are currently only two FDA-approved medications for the treatment of EPM 
onazuril (Marquis®) and Diclazuril (Protazil).
The main concern, however, is the percentage of horses that relapse days, weeks or even months after treatment. Exactly why horses relapse is unclear, but there are three possible reasons: 1) the parasite that causes the disease, Sarcocystis neurona, came out of a form of hibernation within the horse’s body, 2) a small but persistent focus of infection was never completely killed off, or 3) the horse was re-exposed to the parasite.
To ensure your horse’s chances for success, I recommend a three-pronged approach. First, in addition to prescription medication listed above, work with your veterinarian to determine if anti-inflammatories such as phenylbutazone (“bute”) or flunixin meglumine (“Banamine”) should be used, if antioxidants such as Vitamin E, Selenium and others might support nervous tissue, and if the B-vitamin folic acid may prevent the deficiency sometimes created with treatment. Also consider natural ingredients that support the immune system and a healthy inflammatory response such as Omega 3 fatty acids and MSM.
Second, continue treatment for as long as your veterinarian advises or until tests on CSF (cerebrospinal fluid) come back negative. With your veterinarian’s recommendation, include physical therapy such as massage, hand walking, and specific stretches or exercises designed to strengthen and support affected parts of the body.
Third, follow the currently recommended suggestions for preventing EPM in your horse, such as keeping the primary host (the opossum) off your property, minimizing contamination of feed, water and grazing areas from intermediate hosts (cats, raccoons, skunks and armadillos), and reducing stress in your horse.
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Lydia F. Gray, DVM MA, currently serves as the Medical Director/Staff Veterinarian for SmartPak Equine. Prior to joining SmartPak, Dr. Gray served as the first-ever Director of Owner Education for the American Association of Equine Practitioners. She has authored numerous articles in publications such as The Horse, Horse Illustrated, Western Horseman and a variety of veterinary journals and magazines. Dr. Gray is also a frequent speaker at horse expos, veterinary conventions and other locations. After graduating with honors from the University of Illinois College of Veterinary Medicine and receiving her Master's Degree in Interpersonal and Organizational Communication, she practiced at the Tremont Veterinary Clinic for several years. Dr Gray is active in the American Veterinary Medical Association and Illinois State Veterinary Medical Association and enjoys training and showing her trakehner Newman in her spare time. Find Dr. Gray on Google+: Find Dr. Gray on Google+
http://mramishaphiyr.wordpress.com/ I started a blog about my horse and her fight with EPM. I plan to document before, during and after treatments… including images and videos. <3
I took in a horse last year with EPM. He couldn’t walk straight and fell down almost once a day. The vet said he had probably had it for years after doing the appropriate tests. We went the non-traditional route of using herbal medicine (Qing Hao San) and within a month he was walking better. 4 months of treatment and we retested him to find no traces of EPM. He is now back to running around the pasture, bucking, rolling and is even under saddle. We go through the appropriate tests every few months and so far, so good. We even went on a 7 mile trail ride a few weeks ago. Perhaps these alternative ‘medicines’ should be looked into and talked about more.
Interesting treatment Hannah. Do you have more information as to dosages, etc? And where do you get Qing Hao San? Thanks!
HOW DO YOU FEED THE QING HAO SAN AND WHERE DO YOU BUY IT?
Where can I buy the herbal medicine (Qing Hao San) .My Horse got a relapse dueto my vet who didn’t give him further medication.He was fine till I didn’t give him his meds anymore.
Has anyone found out where to get Qing Hao San?
My horse had epm. He was treated, and the vets said he made a full recovery, and 6 months after the all clear to go back to work he fell down again. My vet recommend I never ride him again for our safety and he’s been a permanent pasture pet since he was 9. I had my new vet look at him when he got his shots and she said he had no signs of neurological issues and he was perfectly fine(he’s 14 now). This new diagnosis confuses me, along with how come he fell after they said he was fine?
EPM isn’t a disease that just goes away forever. In fact, most horses have already been exposed to the cause – the protazoa. Horses who have been diagnosed with EPM are subject to recurrences of this disease – so it may come and go. As the owner, you have to be totally in tune with your horse – what’s normal or not for him, particularly his gait. Horses with EPM are often recommended to never be ridden because you can never really know when you’re going to get them past the point of being neurologically sound. Remember, dead nerves never ever grow back; nerves around them try to take up the slack. So for your horse, if you see anything funky, retest him. A test from Florida costs 38 dollars to do. We just paid less than 200 dollars for our test, results, vet visit, and a coggins – things are better now. He probably fell because he had a relapse of EPM. Be sure to keep his immune system strong. vitamin E supplementation helps, as do immune supplements. smart-Pak has tons of them – very affordable.
By the way, even though a veterinarian cannot necessarily recommend a horse be ridden again, with care and rehabilitation and very VERY special attention paid to warning signs of recurrent EPM, many horses are able to go back to productive riding. Some don’t, but in our case we were lucky. My cutting horse I will never really trust to work in cutting again in competition, but he can be ridden working cattle, some light cutting, etc.
i have had two horses with epm. the 1st had to be put down due to the disease progressed to seizures and unable to move hindquarters and blindness. i am now in my 2nd battle with the best horse i have ever had the priviledge to own. we are on our 3rd relapse since 10/11. trying to support him with vitamin e and microlactin. also have been doing at home rehab and chiropractic and massage therapy. would like to donate him to a program studying this horrible disease for research. any suggestions? thank you for your response.
Where are you located? Are you near Florida? Have you talked to your veterinarian about donation? With what are you treating?
My horse was just diagnosed with EPM. My vet believes we caught it early so I’m hoping for the best. Currently she’s being treated with Oroquin-10 and 2 bute for the duration of the treatment. I’m now giving her some vitamin E and Selenium with her vitamins. Can you recommend any specific supplements, vitamins, etc that I should keep her on after the 10 day treatment is over? I want to do anything I can to keep her healthy.
Hi Karen – Thank you for your question! We would recommend that take a look at these two articles below as a good reference. If we can answer any specific questions for you, please call our Customer Care team at 1-888-752-5171 and one of our Product Specialists would be delighted to give you a full supplement consultation for your horse.
http://www.smartpakequine.com/health_and_nutrition/diseases_and_conditions/EPM.aspx
http://blog.smartpakequine.com/2010/07/what-do-you-recommend-for-an-epm-survivor/
My first show horse who is now 13 was diagnosed with EPM about three months ago, he is currently on Marquis and lots of different vitamins to help with his immune system. He has no sense of where his front right leg is and is constantly dragging it around. We do turn him out and so far he is fine but is there anything else you would suggest? He was on marquis for the first month then switched to another medication which made him worse so we then switched back.
Hi Katie, our first recommendation is to make sure you continue working with your vet to monitor your horse’s progress and condition. In addition to the medication your vet is prescribing, you may want to ask him or her about adding Vitamin E to your horse’s diet. Many veterinarians suggest horses undergoing treatment for EPM be supplemented with Vitamin E to support their muscle and nervous tissue. We’ve included a link to our Natural Vitamin E below. Best of luck!
Natural Vitamin E: http://www.smartpakequine.com/natural-vitamin-e-by-smartpak-formerly-smarte-4273p.aspx
I have a 3 year old bucking horse stallion that came down with EPM. He went down today and can get him back up but only for about 5 minutes. He has no clue where his hindend is. I’m starting him on Marquis tomorrow. He is eating and drinking great. What are his chances for survival?
I have four rescues and I often donate money food and computers to a local rescue. I just found out Joey my paint I have got at Christmas from a rescue has EPM, early stages the meds are between 700-1000 and I just don’t have it. I normally do pretty well but its been a tough 2012. I was told sometimes rescues will help. Please help me save Joey.
I have a 25 year old TB that relapsed after 60 days and 90 days on SMZs.
She was then treated with Oroquin 10 and is doing well. The Oroquon 10 in less than $200 and is a 10 day treatment. It was easier on her body then the SMZs as well. http://www.pathogenes.com. Good luck and best wishes to you and Joey.
Ask your vet about payment options. Most of the time your vet will work with you on the bills, as long as you pay them some money each month they should be willing to help you out. I was $7000 in and quite a few wrong diagnoses before one of my vets figured out that it was EPM causing my horse’s problems. Trust me when I say they’ll work with you.