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Case Analysis

Clinical signs of EPM vary from acute to chronic. Often signs of neuromuscular disease include weakness, unusual or atypical lameness, behavior changes, seizures, and recurring signs after treatment. Using a decision tree EPM Chart  may help you form a plan.

For an accurate antemortem diagnosis conduct a complete neurologic examination, Gait Assessment Score, including an evaluation of the gait.  Be aware of signs that occur during acute infection, Early Signs 2003 . Rule out other causes of neurologic disease using radiographs (cervical) or ultrasound and other available tools.

It is possible for three diseases to look alike EPM, it is important to have a good history and determine relapsing disease.  For a discussion of the diseases that should be considered read, Diseases Associated with EPM 2017.

Use immunodiagnostic testing of serum and CSF. Determine the suitability of the case for field trial enrollment, review the parameters for enrollment on the Clinical Trial tab. Submit samples for testing using Submission Form.  The appropriate initial tests for suspect EPM are the SAG 1, 5, 6 for sarcocystosis and the CRP.  Your sample will be saved for 6 months if additional testing is required.  Review the test results, EPM Chart and if necessary, add additional testing.

Determine the appropriate treatment.  The most complete information on licensed treatments for S neurona can be found in the Freedom of Information summary, FOI Marquis FIS Protazil. The expectation of effectiveness can be determined from these documents. Qualified horses can enroll in field trials, call to review the qualifications and obtain the Owner Consent Form that is trial specific. To enter the trial you may need additional documentation and testing,  be sure to call prior to treatment.

Post-treatment evaluation is important.  We recommend a post-treatment examination at 10 days after initiating treatment.  Assess the gait score and complete a second form, Gait Assessment Score.  If the horse has not returned to a GAS 0, consider additional testing or call to discuss the case. If this is a horse with a chronic relapsing history consider polyneuritis Polyneuritis equi Ellison 2015 and Ellison 2015 Polyneuritis equi assay or 2016 S fayeri.