EPM Articles

EPM: Understanding this Debilitating Disease

Equine Protozoal Myeloencephalitis (Horseman's Day 2!"
Pre#ention o$ Equine Protozoal Myeloencephalitis (EPM"
Does %our Horse Ha#e EPM and Ho& 'an %ou (e )ure*

EPM: Understanding this Debilitating Disease
EQUINE PROTOZOAL MYELOENCEPALITI!
Understanding This Debilitating Disease
Equine Protozoal Myeloencephalitis (EPM" is a master o$ disguise+ ,his serious disease can be
di$$icult to diagnose because its signs o$ten mimic other health problems in the horse and signs
can range $rom mild to se#ere+
More than -. o$ all horses in the United )tates may ha#e been e/posed to the organism that
causes EPM+ ,he causati#e organism is a protozoal parasite called Sarcocystis neurona+ ,he
disease is not transmitted $rom horse to horse+ 0ather1 the protozoa are spread by the de$initi#e
host1 the opossum1 &hich acquires the organism $rom cats1 raccoons1 s2un2s and armadillos and
possibly e#en $rom harbor seals and sea otters+ ,he in$ecti#e stage o$ the organism (the
sporocysts" is passed in the opossum's $eces+ ,he horse comes into contact &ith the in$ecti#e
sporocysts &hile grazing or eating contaminated $eed or drin2ing &ater+
3nce ingested1 the sporocysts migrate $rom the intestinal tract into the bloodstream and cross the
blood4brain barrier+ ,here they begin to attac2 the horse's central ner#ous system+ ,he onset o$
the disease may be slo& or sudden+ 5$ le$t undiagnosed and untreated1 EPM can cause
de#astating and lasting neurological damage+
)%MP,3M)
,he clinical signs o$ EPM can be quite #aried+ 'linical signs are usually asymmetrical (not the
same on both sides o$ the horse"+ 6ctual signs may depend on the se#erity and location o$ the
lesions that de#elop in the brain1 brain stem or spinal cord+ )igns may include:
6ta/ia (incoordination"1 spasticity (sti$$1 stilted mo#ements"1 abnormal gait or lameness
5ncoordination and &ea2ness &hich &orsens &hen going up or do&n slopes or &hen
head is ele#ated
Muscle atrophy1 most noticeable along the topline or in the large muscles o$ the
hindquarters1 but can sometimes in#ol#e the muscles o$ the $ace or $ront limbs
Paralysis o$ muscles o$ the eyes1 $ace or mouth1 e#ident by drooping eyes1 ears or lips
Di$$iculty s&allo&ing
)eizures or collapse
6bnormal s&eating
7oss o$ sensation along the $ace1 nec2 or body
Head tilt &ith poor balance8 horse may assume a splay9$ooted stance or lean against stall
&alls $or support
)e#eral $actors may in$luence the progression o$ the disease1 ho&e#er these $our things appear
to be important:
:+ :+ ,he e/tent o$ the in$ection (i+e+ the number o$ organisms
ingested"
2+ 2+ Ho& long the horse harbors the parasite prior to treatment
!+ !+ ,he point(s" in the brain or spinal cord &here the organism
localizes and damage occurs
;+ ;+ )tress$ul e#ents $ollo&ing in$ection or stress$ul e#ents &hile
in$ected
H30)E) 6, 05)<
EPM is considered the number9one cause o$ neurologic problems in horses today+ 6lmost e#ery
part o$ the country has reported cases o$ EPM+ Ho&e#er1 the incidence o$ disease is much lo&er
in the &estern United )tates1 especially in regions &ith small opossum populations+ Ho&e#er1 due
to the transport o$ horses and $eedstu$$s $rom one part o$ the country to another1 almost all horses
are at ris2+
=ot all horses e/posed to the protozoan Sarcocystis neurona &ill de#elop the disease and sho&
clinical signs o$ EPM+ )ome horses seem to mount an e$$ecti#e immune response and are able to
combat the disease be$ore it gains a $oothold+ 3ther horses1 especially those under stress1 can
succumb rapidly to the debilitating e$$ects o$ EPM+ )till others may harbor the organisms $or
months or years and then slo&ly or suddenly de#elop symptoms+
D56>=3)5)
%our #eterinarian &ill $irst conduct a thorough physical e/amination to assess your horse's
general health and identi$y any suspicious signs+ 3ne notable clue is the disease o$ten tends to
a$$ect one side or part o$ the horse more than another+
5$ your equine practitioner suspects EPM1 he or she may order blood and cerebrospinal $luid
(')?" analysis+ Cerebrospinal fluid may be collected by way of a special needle inserted into the
spinal canal either in a site on the lower back or at the poll. Potential risks are involved with the
procedure that should be discussed with your veterinarian. 6 positi#e blood test only means the
horse has been e/posed to the parasite1 not that it has or &ill de#elop clinical disease+ 'urrently
three laboratories are analyzing blood and spinal $luid $or the prescence o$ S. neurona antibodies+
Prompt1 accurate diagnosis is essential and treatment should begin immediately+
,0E6,ME=,
,he sooner treatment begins1 the better the horse@s chances are $or reco#ery+ )i/ty to A. o$
EPM cases aggressi#ely treated sho& signi$icant or complete re#ersal o$ symptoms+ Many horses
are able to return to normal acti#ity+ Here are some things you should 2no& about treating EPM:
6t present1 there are t&o labeled anti9protozoal drugs appro#ed by the ?D6 to treat EPM+
,here are also combination therapies that may include sul$a antibiotics and anti9$olate
medications+ 'onsult your #eterinarian+
6nti9in$lammatory drugs may be prescribed to alle#iate symptoms and pre#ent reactions
to parasite die9o$$ during treatment+
)upplementation &ith #itamin E1 an antio/idant1 is o$ten recommended to aid healing o$
ner#ous tissue+
6#erage duration o$ treatment is one month &ith the proprietary products1 although
depending on &hich medication is used can sometimes be longer (up to !9B months &ith
combinations"+
,reatments can be e/pensi#e+
6lthough complications are rare1 treatments may a$$ect stallion $ertility and may pose
certain health ris2s to unborn $oals+
Chile success rates are high1 not all horses respond positi#ely to therapy+ 6ppro/imately
:92. o$ horses may e/perience a relapse+
Chile a horse is being treated1 ta2ing intermittent blood samples may be recommended
to monitor potential side e$$ects such as anemia1 lo& platelet count and lo& &hite blood
cell count+
)ome drugs used to treat EPM are anti$olate drugs+ ,here$ore1 periodic e/amination $or
anemia is indicated during treatment+
Horses undergoing treatment should be closely obser#ed $or signs o$ impro#ement or
decline1 especially negati#e side e$$ects to the drugs1 such as acute diarrhea+
(e sure to report any changes in the horse@s condition to your #eterinarian+
ME,H3D) 3? P0EDE=,53=
(ased on published research1 there are se#eral things horse o&ners can do to protect their
horses $rom in$ection &ith EPM+ ,here is currently a #accine to immunize against Sarcosystis
neurona8 ho&e#er1 the e$$icacy is un2no&n at this time+ 6t best1 good horse92eeping practices &ill
discourage un&anted #isitors such as opossums and other rodents $rom contaminating hay1 grain
and bedding+
Here are a $e& suggestions:
E <eep $eed rooms and containers closed and sealed+
E Use $eeders1 &hich minimize spillage and are di$$icult $or &ild animals to access+
E 'lean up any dropped grain immediately to discourage sca#engers+
E ?eed heat9treated cereal grains and e/truded $eeds since these processes seem to
2ill the in$ecti#e sporocysts+
E <eep &ater tan2s clean and $illed &ith clean1 $resh &ater+
E Ma/imize your horse's health and $itness through proper nutrition1 regular e/ercise
and routine de&orming and #accinations+
E )chedule regular appointments &ith your equine #eterinarian+
3=>35=> 0E)E60'H
EPM &as initially identi$ied in :FB;+ 5n recent years1 a&areness among #eterinarians and horse
o&ners has gro&n considerably+ 0esearch at the Uni#ersity o$ <entuc2y1 the Uni#ersity o$ ?lorida1
3hio )tate Uni#ersity1 the Uni#ersity o$ 'ali$ornia at Da#is1 Uni#ersity o$ Missouri1 Dirginia ,ech
and Uni#ersity o$ Maryland and Michigan )tate Uni#ersity1 as &ell as other institutions1 is leading
to ad#ancements in EPM diagnosis1 treatment and the li$e cycle o$ S. neurona+
?or more in$ormation regarding EPM1 contact your #eterinarian+
6merican 6ssociation o$ Equine Practitioners
;A- 5ron Cor2s Par2&ay
7e/ington1 <% ;-::
(G-F" 2!!9:;A


posted: B42A42-+ 7ast updated: B42A42-+
E"#ine Pr$t$%$al M&el$ence'halitis ($rse)an*s Da&
+,,-.
b& /ent$n M$rgan0 D1M0 DACT (Presented d#ring $rse)an*s Da&
+,,-0 Ne2 Orleans0 La3.
Equine protozoal myeloencephalitis (EPM" is a disease o$ horses that a$$ects the central
ner#ous system+ Equine ob#iously re$ers to the horse1 protozoal re$ers to the type o$ organism
that causes the disease and myeloencephalitis re$ers to that portion o$ the animal &hich is
damaged+ HMyeloI re$ers to the spinal cord and HencephalitisI re$ers to an in$ection4in$lammation
o$ the brain+ )o1 EPM is a disease o$ the brain and4or spinal cord o$ the horse1 &hich is caused by
a protozoan organism+
Chat is a protozoa* Protozoa are the smallest and most simplistic members o$ the animal
2ingdom+ ,hey are single9celled organisms+ ,he name gi#en to the protozoan organism sho&n to
be the causati#e agent $or EPM is )arcocystis neurona+ )arcocystis re$ers to the type o$
protozoan parasite and neurona re$ers to the ner#ous system &here this organism &as $irst
isolated+
,he disease &as described in the :FBs as segmental myelitis+ (y :FA; &e determined this
disease &as caused by a protozoan organism+ 5n :FAB it &as concluded that some type o$
)arcocystis organism &as the culprit+ ,his organism ()arcocystis neurona" &as $irst isolated $rom
the spinal cord o$ a horse &ith clinical signs o$ EPM in the early :FFs+ 5n the mid9:FFs1 another
organism called =eospora hughesi &as sho&n to cause EPM in horses+ ,his organism1 ho&e#er1
is #ery rare in comparison to )+ neurona as a cause o$ EPM and is considered to be
inconsequential and &ill not be discussed here+
'urrently1 EPM is a disease o$ the Cestern Hemisphere+ Ce $ind this disease only in horses that
reside in =orth or )outh 6merica or in horses that once spent time in the Cestern Hemisphere+
,here is a report o$ horses in ?rance that ha#e ne#er le$t that country ha#ing signs and lesions
consistent &ith EPM+ ,here is still some speculation i$ this disease in#estigation (in ?rance" is
accurate+
Ce do 2no& that many horses are e/posed to the )+ neurona parasite+ Ce 2no& this is true by
doing speci$ic testing on blood samples ta2en $rom horses around the country+ ,he blood sample
is e#aluated to determine i$ it contains antibodies speci$ic to the )+ neurona organism+ 5$ the
sample contains these antibodies1 then &e 2no& the horse has been e/posed to this parasite and
has mounted an immune response+ Ce say the horse is Hsero9positi#eI &ith antibodies against )+
neurona+ 5t does not tell us i$ the horse &ill e#er de#elop EPM+ 5t Just tells us the horse has been
e/posed+ Most horses in the United )tates &ill demonstrate this antibody in their blood+ 5n some
areas o$ the country o#er F. o$ horses can be Hsero9positi#e+I 7uc2ily1 only a #ery small
percentage o$ horses e#er de#elop the disease &e call EPM+ ,he actual disease rate or incidence
is di$$icult to estimate+ 0esults $rom a #ery large equine sur#ey completed by the U)D6 a $e&
years ago estimated the actual disease incidence to be appro/imately +:;. in the general
equine population+ )o1 e#en though the maJority o$ the equine population is e/posed to this
parasite1 only a #ery small percentage e#er de#elops clinical disease+
Parasite 7i$e 'ycle
Much has been learned in the last : years &ith respect to the li$e cycle o$ )+ neurona+ Ho&e#er1
there is still much &e do not 2no&+
)arcocystis neurona has a comple/1 t&o9host li$e cycle+ ,his li$e cycle includes both de$initi#e
hosts and intermediate hosts+ ?or clari$ication1 the de$initi#e host is that animal &hich sheds an
in$ecti#e $orm o$ the parasite1 )+ neurona+ ,he intermediate host is that animal &hich does not
shed an in$ecti#e $orm but is a host &here the parasite resides and is necessary $or the parasite
to complete its li$e cycle+ 5t &as not until :FF- that the opossum &as determined to be the
de$initi#e host o$ this parasite (there may #ery &ell be other de$initi#e hosts $or this organism and
&e ha#e Just not yet identi$ied them"+ ,he opossum sheds the in$ecti#e $orm o$ the parasite in the
$eces8 &e call this in$ecti#e $orm a Hsporocyst+I ,he sporocyst is then ingested or eaten by the
horse+ 3nce inside the horse1 there is much that &e do not 2no& regarding &hat occurs ne/t+ ,he
parasite does go through a maturation or reproducti#e phase and e#entually produces a $orm o$
the parasite &e call Hmerozoites+I E#entually (in only a #ery small percentage o$ horses" the
merozoites reach the central ner#ous system1 damage this #ital area and create the disease
condition &e call EPM+
6s $or intermediate hosts1 there are se#eral8 currently &e 2no& that s2un2s1 armadillos1 raccoons1
cats and sea otters can ser#e as intermediate hosts $or the )+ neurona parasite+ ,his list
undoubtedly &ill continue to gro& as &e learn more about this protozoan parasite+ ,he $ollo&ing
diagram helps illustrate the comple/ li$e cycle o$ )arcocystis neurona+
)ince &e do not belie#e the horse is a HnormalI host $or this parasite1 &e re$er to the horse as an
aberrant1 intermediate host+ Ho&e#er1 some #ery recent &or2 may suggest that the horse is a true
intermediate host $or this parasite+
Chat does EPM loo2 li2e*
)ince EPM is a disease o$ the central ner#ous system (brain and spinal cord" and it can a$$ect
multiple locations &ithin the brain and spinal cord1 the signs and se#erity o$ this disease can #ary
dramatically+
,hough EPM can a$$ect both the brain and spinal cord1 it is more common $or the signs o$ disease
to be associated &ith damage to the spinal cord+ (ut &e can and do see insult to the brain+
Ce typically re$er to the ! H6Is o$ this disease: 6symmetry1 6ta/ia and 6trophy+ 6symmetry is a
term &e use to describe a symptom that is &orse on one side o$ the body than on the opposite
side+ 5n other &ords1 &ith EPM1 the signs are generally &orse on the le$t side than on the right or
#isa #ersa+ 6ta/ia is a term &e use to describe incoordination or the inability o$ the horse to mo#e
its legs and trun2 normally+ 6trophy describes a condition &here the muscles decrease $rom their
normal size+ Cith EPM this results $rom damage to the ner#es that normally control or Hinner#ateI
these muscles+ Muscle atrophy is not seen in all cases o$ EPM1 so it is not as consistent a sign o$
disease as is the asymmetrical ata/ia+ )o1 &ith this disease &e &ill see horses that are
incoordinated and this incoordination is &orse on one side o$ the body as compared to the other
side+ ,hese horses may or may not de#elop muscle atrophy+
5t is also common to see muscle &ea2ness in these horses+ )ome horses may display abnormal
gaits1 lameness and loss o$ sensation along the $ace1 nec2 or body+ Paralysis o$ the muscles o$
the eyes1 $ace or mouth may occur and this &ill be e#ident by drooping eyes1 ears or lips+ Horses
may also demonstrate a head tilt1 poor balance and di$$iculty in s&allo&ing or #ocalizing+ 3n rare
occasion e#en seizures and collapse may occur+
,his disease may progress rapidly or #ery slo&ly+ Horses generally deteriorate o#er time but
some animals may Hle#el o$$I or plateau $or a period o$ time only to &orsen days1 &ee2s or e#en
months later+ Most horses a$$licted &ith this debilitating disease continue to ha#e a bright1 alert
temperament+
Ho& do &e diagnose EPM*
6s you can see $rom the preceding discussion1 clinical signs o$ this disease can #ary signi$icantly1
and no t&o horses &ith EPM &ill loo2 e/actly the same+ ,hat is one o$ the $actors that ma2e the
accurate diagnosis o$ this disease such a challenge+ 6nother $actor is that there are se#eral
diseases o$ the central ner#ous system o$ the horse that can loo2 #ery similar to EPM1 especially
in the early stages o$ the disease process+ 6nd $inally1 there is no single HtestI that can be done
&hich is :. accurate in the li#e horse that can tell us i$ a particular animal is su$$ering $rom
EPM+ ,here are tests that can be utilized by your #eterinarian1 and these are used to support his
or her diagnosis o$ EPM as &ell as to rule out other diseases &hich may loo2 li2e EPM+ 5t is
important to remember that &e can ne#er be absolutely sure a particular horse has EPM+
,he most important e#aluation done by your #eterinarian as he or she begins their diagnostic
&or29up $or a suspected case o$ EPM is the neurologic e/amination+ ,his is a specialized e/am
that is done to e#aluate the $unction o$ the central ner#ous system o$ the horse+
5t may also be necessary that radiographs be ta2en o$ the nec2 region o$ the horse+ ,his is done
to determine i$ there is any type o$ compression on the spinal cord+ 'linical signs $rom pressure
on the spinal cord o$ the horse can loo2 #ery much li2e EPM+ ,his type o$ condition has se#eral
names but the most common term used is H&obblers+I ,his is an important Hrule outI &hen
e#aluating a horse $or EPM+
%our #eterinarian may also dra& blood during the e/amination process+ 5n some cases1 he or she
may decide to collect spinal $luid $rom the horse by doing a spinal tap+ ,his can be use$ul to
support the diagnosis o$ EPM and also to help rule out other diseases o$ the central ner#ous
system+
EPM is a challenging diagnosis1 and in certain cases treatment o$ the horse may be part o$ this
process+ 5n other &ords1 a horse may be treated $or EPM &ith only minimal diagnostic e$$orts
e/pended+ 5$ the animal impro#es then it is concluded the horse did ha#e EPM+ 5$ the horse does
not impro#e1 then $urther diagnostic e$$orts may be necessary+ ,his approach should only be
considered a$ter care$ul consultation &ith your #eterinarian+
Ho& do &e treat EPM*
Kust as &ith our diagnostic e$$orts1 treatment o$ EPM should only be done under the direct
super#ision o$ your #eterinarian+ Cith all types o$ li$e9threatening disease1 it is important that you
recognize1 diagnose and treat early $or the best possible outcome+ 'urrently there is only one
?D69appro#ed treatment $or EPM+ ,his is a product called MarquisL1 &hich is manu$actured by
(ayer 6nimal Health+ ,he acti#e ingredient is ponazuril+ ,his product is a paste $ormulation and is
gi#en once daily $or 2G consecuti#e days+ ,he drug has demonstrated e$$ecti#eness in treating
horses &ith EPM and has a #ery $a#orable sa$ety pro$ile+
6nother less common treatment is the combination o$ sul$adiazine and pyrimethamine+ ,his drug
combination is generally gi#en once daily $or a minimum o$ three months+ 5t is not uncommon $or
treatment to e/tend as long as si/ months+ Horses &ith EPM can respond $a#orably to this
treatment program+ Cith long9term sul$a treatment there are recognized sa$ety concerns+ Horses
can de#elop anemia and su$$er abortions1 birth de$ects and occasional stallion dys$unction &ith
long9term therapy+ 5t is also recommended that this product be gi#en on an empty stomach+
5t is also common $or #eterinarians to use other supporti#e or ancillary drugs &hile treating EPM+
,hese treatments can include anti9in$lammatory products such as corticosteroids1 bute1
(anamineL1 DM)3 and others+ )ome practitioners may also supplement &ith #itamin E &hile
treating neurologic disease+ 3thers may try to stimulate the immune system by using one o$
se#eral immune9modulating products on the mar2et+ 5t is also recommended that horses be
remo#ed $rom stress$ul en#ironments and acti#ities &hile recei#ing treatment $or EPM+
5n the near $uture1 there may be other treatment options+ 5t is reported that 5DEMM is close to ?D6
appro#al o$ a drug $or the treatment o$ EPM1 and )chering is also &or2ing on an EPM treatment+
5t is important to remember that success$ul treatment may eliminate the parasite1 but the e$$ects
$rom damage to the central ner#ous system by the parasite can be permanent+
Chat can 5 do to help pre#ent or minimize the ris2 o$ EPM*
Horse o&ners can ta2e ad#antage o$ some basic husbandry practices and good common sense
to help reduce the ris2 $actors that can contribute to disease incidence+ 3ne thing that all o$ us
can do is to 2eep our $eed storage areas neat and clean+ Untidy areas &ith spilled $eed in#ites
un&anted guests such as opossums+ <eep your $eed in sealed or closed containers+ 'o#er your
hay storage area i$ possible+ <eep rodents under control on your property+ Discourage #isits by
opossums+ 'hec2 &ith local authorities &ith respect to trapping and relocating opossums or
eliminating them+ Properly dispose o$ any animal carcasses that you may see on or near your
property+ 'lean your equine &ater sources on a regular basis+ Do not $eed on the ground+ Chen
transporting horses1 ma2e them as com$ortable as possible+ ,ransportation stress can be a
contributing $actor $or EPM+ ,here is a conditionally licensed #accine manu$actured by ?ort
Dodge 6nimal Health+ ,he #accine has not demonstrated e$$icacy &ith respect to the pre#ention
o$ EPM1 but ?ort Dodge is acti#ely supporting studies in this regard+ ,he product has
demonstrated sa$ety &hen used as directed+
Equine Protozoal Myeloencephalitis (EPM" )ummary Points
>eneral comments:
N EPM is an acronym $or Equine Protozoal Myeloencephalitis
N Disease o$ the brain and4or spinal cord in the horse
N 'aused by a protozoan parasite that is transmitted by the opossum
N Di$$icult to accurately diagnose
N Early diagnosis and treatment #ery important
N )arcocystis neurona is the protozoan pathogen o$ EPM
N =o horse9to9horse transmission
N 'irculating antibodies to )+ neurona indicate the horse has been e/posed to the parasite1 but
does not indicate acti#e disease (&e call this sero9positi#e"
N 5n some geographic locations1 o#er F. o$ horses may be sero9positi#e1 in others $ar less
N 6 large equine sur#ey indicated only about +:;. o$ horses &ill de#elop clinical disease
N 'urrently1 &e are #ery close to a reliable challenge model $or this disease in horses
7i$e 'ycle o$ )arcocystis neurona
N )+ neurona has a comple/1 t&o9host li$e cycle
N ,he opossum has been identi$ied as a de$initi#e host o$ )+ neurona
N ,he opossum ingests sarcocysts $rom the tissues o$ the intermediate hosts
N ,he parasite undergoes a $orm o$ se/ual reproduction &ithin the opossum &hich produces the
sporocyst
N )porocysts are shed in the $eces o$ the opossum
N )porocysts can sur#i#e in the en#ironment $or se#eral months
N ,he horse is an aberrant1 intermediate host
N ,he horse is e/posed by ingesting $eed or &ater contaminated &ith opossum $eces that contain
sporocysts
N ,he parasite undergoes a $orm o$ ase/ual reproduction in the horse and e#entually gains
access to the brain and spinal cord
N 5ntermediate host
N ,he armadillo1 striped s2un21 cat1 raccoon and sea otters can ser#e as intermediate hosts
N 0ecent &or2 has demonstrated sarcocysts in the horse8 there$ore1 the horse may ser#e as a
true intermediate host
N ,he intermediate host pic2s up the parasite $rom ingesting sporocysts
N ,he parasite goes through an ase/ual reproduction stage and produces tissue sarcocysts (cysts
in the muscle tissue"
N ,his stage then is the source o$ in$ection $or the opossum (&hich ingests these in$ected tissues
containing sarcocysts" and the li$e cycle is completed
'linical )igns
N Progressi#ely debilitating disease a$$ecting the '=) (brain and spinal cord"
N 'an be acute or gradual onset
N Disease may in#ol#e brain1 brain stem1 spinal cord or any combination thereo$
N Disease may progress #ery rapidly or slo&ly
N Disease may stabilize only to resume progression days1 &ee2s or months later
N Horses are usually bright and alert during course o$ disease
N Horses typically do not ha#e ele#ated temperatures
N )igns may include any o$ the $ollo&ing:
N )ubtle lameness
N Cea2ness
N 6ta/ia1 incoordination
N Usually asymmetrical1 one or all limbs
N Muscle atrophy
N Head tilt
N Head sha2ing
N 'ranial ner#e signs1 such as asymmetrical $acial paralysis1 head tilt or s&allo&ing di$$iculties
N (eha#ioral abnormalities1 seizures
N 0ecumbency
Diagnosis
N 6 thorough physical and neurologic e/am is the most important part o$ the diagnostic process
N 0adiographs o$ the nec2 region i$ indicated by your #eterinarian
N (lood &or2 i$ indicated by your #eterinarian
N )pinal tap i$ indicated by your #eterinarian
N Di$$erential Diagnosis (0ule outs"
N 6ny instability or abnormality o$ the #ertebrae o$ the nec21 such as H&obblersI
N Equine Herpes #irus in$ection o$ the brain and spinal cord
N 3ther #iral disease o$ the brain and spinal cord such as rabies1 EEE1 CEE1 Cest =ile #irus
N EM=D (equine motor neuron disease"
N 5nJury4trauma o$ the spinal cord or brain
N EDM (equine degenerati#e myeloencephalopathy"
N Polyneuritis Equi (P=E1 including cauda equina"
N ,umor or abscess o$ the brain or spinal cord
,reatment
MarquisL paste is currently the only ?D6 appro#ed treatment $or EPM+
N Marquis
N 3nce daily paste treatment $or 2G consecuti#e days
N =o restriction regarding H$ullI or HemptyI stomach
N Cide margin o$ sa$ety
N Use o$ this product in animals intended $or reproduction or in pregnant or lactating mares has
not been e#aluated
)u$adiazine4pyrimethamine is readily a#ailable in the U+)+ mar2et
N >i#en daily
N 0ecommended it be gi#en on an empty stomach
N >i#en $or three to si/ months
N )ide e$$ects include anemia1 abortion1 birth de$ects1 stallion dys$unction
6dditional ?D69appro#ed treatments &ill be on the mar2et soon
Pre#ention
E Decrease presence o$ opossums
E <eep grain stored and $eed area clean
E <eep &ater sources clean
E <eep hay co#ered i$ possible
E 0odent control
E Do not $eed on the ground
E 5mmediately remo#e and bury carcasses o$ s2un2s1 armadillos1 cats and raccoons &hene#er
possible
E 'onditionally licensed #accine is a#ailable $rom ?ort Dodge
posted: 24;42;+ 7ast updated: 24;42;
Pre4enti$n $5 E"#ine Pr$t$%$al M&el$ence'halitis (EPM.
b& 6& 7illia) !a4ille0 D1M0 Di'l AC1IM0 PhD0 !te'hen Reed0 D1M0
Di'l AC1IM and 83P3 D#be&0 M1!c0 PhD (s$#rce: Presented
d#ring the +,,+ AAEP Ann#al C$n4enti$n in Orland$0 9la3 .
5ntroduction
Equine protozoal myeloenencephalitis (EPM" is one o$ the most important neurologic diseases in
the horse+ Pre#ention o$ the disease has been paramount in the mind o$ #eterinarians as &ell as
horse o&ners8 ho&e#er1 it may be much more di$$icult than anyone imagined+ 6s &e learn more
about the disease1 &e $ind that &ildli$e management1 ris29$actor manipulation1 prophylactic
medications and possibly #accination may all be mechanisms utilizable $or pre#ention o$ EPM+
De$initi#e Host
6lthough the disease has recei#ed much publicity1 scienti$ic 2no&ledge has been sorely lac2ing
regarding pathophysiology o$ the disease and the mechanisms by &hich the parasite has been
maintained in nature+ 5n the last :- months1 tremendous strides ha#e been made in sol#ing the
li$e cycle o$ the organism+ <no&ledge regarding the li$e cycle may be utilized as one maJor
modality in the pre#ention o$ EPM+ 3riginal research in the mid9:FFs led to the disco#ery o$ the
opossum as the de$initi#e host $or )arcocystis neurona1 the primary parasite that causes EPM in
horses+ Most )arcocystis spp+ ha#e a predator9prey li$e cycle1 &hich allo&s the parasite to cycle
in nature and to perpetuate itsel$+ Ha#ing sol#ed the de$initi#e host equation1 this disco#ery led to
erroneous conclusions that the parasite had a bird9opossum li$e cycle+ 5t too2 se#eral years
be$ore this &as recti$ied &hen the opossum turned out to be the host o$ at least three )arcocystis
spp+ Ho&e#er1 this did not help to elucidate the prey arm or intermediate host o$ the )+ neurona
li$e cycle+
5ntermediate Hosts
'at
'ompletion o$ the li$e cycle $or )+ neurona &as $irst accomplished in a laboratory setting by using
the domestic cat as the intermediate host species+ )ubsequent &or2 by the same research group
e/amined e/posure rates o$ barn and $eral cats to )+ neurona in the state o$ 3hio+ Horse $arms
&ere targeted &here there &ere horse cases o$ EPM1 there &ere resident cats and the $arms
&ere in syl#atic areas1 hence &ildli$e present+ E/posure rates o$ cats to )+ neurona &ere high (;
percent" on these premises+ 6nother subset o$ cats that &ere presented to a mobile spay9and9
neuter clinic &ere sampled1 and those cats had a much lo&er (: percent" e/posure rate+ ,hese
studies suggest that the domestic house cat does play a role in transmission o$ )+ neurona in
nature and there$ore li2ely has an impact on EPM in the horse+ ,he e/tent to &hich the cat is
in#ol#ed needs to be determined be$ore &e understand ho& big a role it may play in the li$e cycle
o$ )+ neurona+
6rmadillo
?ollo&ing publication o$ the cat as the intermediate host1 a natural intermediate host &ith high
le#els o$ e/posure to )+ neurona &as reported: the nine9banded armadillo+ 6ll :F &ild9caught
armadillos had detectable )+ neurona antibodies in their serum+ ,his $act coupled &ith the
production o$ sporocysts a$ter $eeding sarcocyst9in$ected muscle $rom road92ill armadillos is
strongly suggesti#e that the nine9banded armadillo is a natural intermediate host $or )+ neurona+
?urther &or2 also needs to be done to determine the e/tent o$ their en#ironment+
)2un2
)ubsequent to the cat and armadillo disco#eries1 a third species &as determined to be a
laboratory intermediate host $or )+ neurona+ ,here &as a report that )+ neurona antibodies &ere
$ound in the striped s2un2+ 'ompletion o$ the li$e cycle &ith the striped s2un2 along &ith the
reports o$ )+ neurona antibodies in &ild s2un2s is also suggesti#e that the striped s2un2 may #ery
&ell be a natural as &ell as a laboratory intermediate host+
0accoon
6nother more recent natural intermediate host to complete the li$e cycle o$ )+ neurona is the
raccoon+ ,his high seropre#alence rate in raccoons is similar to the e/posure rate in horses+ ,his
$inding o$ high e/posure rates in combination &ith the $eeding o$ &ild9caught raccoon muscle to
produce sporocysts ma2es $or a compelling argument that the raccoon is an ideal intermediate
host in the li$e cycle o$ )+ neurona+
)ea 3tter
,he latest intermediate host to complete the li$e cycle o$ )+ neurona thus $ar is the sea otter+ ,he
role o$ the sea otter in the contamination o$ the en#ironment &ith )+ neurona sporocysts is li2ely
limited+ Ho&e#er1 &hat it does demonstrate is that the number o$ natural intermediate hosts may
be numerous and thus ma2e pre#ention o$ contamination o$ the en#ironment di$$icult8 there$ore1
pre#ention o$ EPM can be di$$icult+
Pre#ention
,he opossum is a sca#enger by nature and &ill eat anything (omni#orous"+ )e#eral studies ha#e
demonstrated the presence o$ domestic cat1 raccoon and striped s2un2 in the stomach contents
o$ the opossum+ Most conclude that the presence o$ the larger mammals &as li2ely the result o$
eating carrion+ 5n addition1 based on these early reports1 it appears that these are not the
pre$erred diet o$ the opossum1 &hich may be the reason &hy early reports ha#e determined that
2 percent or less o$ the opossums e/crete )+ neurona sporocysts+ ,he $act that these mammals
&ould not be considered prey li2ely resulted in a di$$erent direction being studied &ith regard to
the true intermediate hosts in#ol#ed in this li$e cycle+
(ased on the eating habits o$ the opossum1 pre#ention o$ EPM becomes problematic due to the
e/cess o$ road92ill on the high&ays across the United )tates+ ,he opossum &ill sca#enge carrion
to sur#i#e i$ other more pre$erred types o$ $ood are not a#ailable+ 'leanup o$ road92ill o$ $our o$ the
abo#e named species in particular &ould help to sol#e some o$ the EPM problems1 as each o$
these species are able to complete the li$e cycle o$ )+ neurona+ Ho&e#er1 gi#en the $act that $our
species that complete the li$e cycle ha#e been disco#ered in the last :29:- months1 it seems
li2ely that more species are in#ol#ed in completing the li$e cycle and &ill add to the e/cretion o$
sporocysts to contaminate the en#ironment+ Pre#enting access o$ opossums to the $arm or ranch
en#ironment is also di$$icult1 particularly i$ $ood and &ater are in short supply+ E#en i$ hay and
grain are 2ept stored in opossum9proo$ $acilities1 there is still no protection o$ grass pastures $rom
contamination &ith )+ neurona sporocysts+ Encouragement o$ horse o&ners to pic2 up dead
species and 2eep them $rom being eaten by opossums is one method o$ pre#ention8 ho&e#er1 the
e$$ort to do this seems problematic+
0ecent publications describing $e& ris2 $actors $or EPM ha#e delineated a $e& measures that
could be manipulated to reduce incidence o$ the disease+ 0esearch $rom 3hio suggests that ris2
$actors $or the disease include age o$ the horse1 occupation o$ the horse1 season o$ the year1
presence o$ &oods on the premises1 presence o$ opossums1 lac2 o$ $eed security1 health e#ents
be$ore diagnosis and pre#ious cases o$ EPM being diagnosed on the $arm+ ,he horse $actors are
#ery di$$icult to manipulate8 ho&e#er1 e$$orts to impro#e the immune status o$ the horse may be
&arranted+ Un$ortunately1 the highest9ris2 occupations are racing and sho&ing o$ horses+ ,his
in#ol#es transport o$ horses to racetrac2s and sho& e#ents1 and transport has been determined
to be a ris2 $actor $or the disease as &ell+ 3ther than stopping the transport o$ horses1 &hich is
#ery unli2ely1 impro#ement o$ immune status &hile in transit may be a solution+ ,he presence o$
&oods and opossums on the property corroborate the $inding that the opossum is the de$initi#e
host and is contaminating the en#ironment8 there$ore1 pre#enting opossum access to property1 or
at least to the horse $eed1 is important in pre#ention+ Un$ortunately1 remo#al o$ &oods $rom the
premises1 &hile remo#ing the opossum habitat1 &ould not li2ely sol#e the problem1 as the
opossum has learned to adapt #ery &ell+ (oth the 3hio and the =6HM) studies (in#ol#ing horses
$rom 2G states across the U+)+" $ound an increased ris2 $or EPM in the $all season o$ the year+
,he reason $or this $inding &as that a lot o$ the maJor horse competitions &ere in the $all1 &hich
also in#ol#ed transport+ Ho&e#er1 perhaps it is related to the change in the opossum diet in the
$all1 as research has determined that the carrion in#ol#es a much bigger percentage o$ the
opossum diet at that time+
6 #accine had been de#eloped $or EPM pre#ention+ ,his is a 2illed #accine using )+ neurona
merozoites+ ,his #accine is conditionally licensed $or use in horses8 ho&e#er1 there is as o$ yet no
clinical e#idence and little research data indicating that the #accine is e$$icacious+ 'urrently there
is a longitudinal study in progress in#ol#ing se#eral uni#ersities and pri#ate practices that may
help in determining i$ the #accine has any e$$icacy in pre#ention o$ EPM+
0ecently1 there has been some e#idence that suggests there are triazene deri#ati#e medications
that &ill pre#ent )+ neurona in mice+ ,he medication used &as diclazuril1 an herbicide that has
been used in se#eral species in other countries as a coccidiostat in both poultry and s&ine+
Diclazuril has been used to treat horses that are diagnosed &ith EPM+ Perhaps this medication as
&ell as other similar compounds may be de#eloped as pre#entati#e therapy in the top dress o$
horse rations+
'onclusions
6lthough &e ha#e made enormous strides in understanding the li$e cycle o$ )+ neurona1 &e ha#e
only a $e& good suggestions regarding pre#ention o$ this disease+ =ot&ithstanding this1 it is
apparent that pre#ention o$ EPM should be centered on the &ildli$e in#ol#ed in the transmission o$
the parasite+ 5t is not the li#e &ildli$e that is the problem &hen considering the intermediate host
as a cause o$ the disease+ 6s $ar as &e 2no&1 the maJority o$ the intermediate hosts in#ol#ed only
play a role &hen they are 2illed or die due to disease+ ,here$ore1 pic2ing up dead s2un2s1
raccoons1 armadillos or cats on your property and disposing the carcasses to pre#ent opossums
$rom eating them may pre#ent many sporocysts $rom contaminating the en#ironment and hence
reduce the incidence o$ the disease+ Manipulation o$ ris2 $actors that are in#ol#ed in the disease
may also help+ 5t remains to be seen &hether the #accine or other pre#enti#e therapies &ill be
use$ul in time+
posted: A4!:42!+ 7ast updated: :24:F42!+
D$es Y$#r $rse a4e EPM and $2 Can Y$# 6e !#re:
b& Pa#l M$rel&0 D1M0 PhD
Paul Morely1 DDM1 PhD
Equine Protozal myeloencephalitis is the tongue9t&isted name o$ one o$ the most pre#alent and
puzzling neurological diseases $ound in horses+ ,he disease began to capture headlines years
ago &hen it &as $irst Hdisco#eredI although it is almost certain it &as present prior to that time+
)ince then1 its causes and cures1 li2e many o$ those diseases a$$ecting the human1 ha#e been the
source o$ contro#ersy among #eterinary researchers and practitioners+
0ecent in#estigations suggest that a protozoal parasite called )arcocystis neurona1 &hich in$ects
the ner#ous system o$ the horse1 is the agent that causes EPM+ 6pparently1 the carrier is the
opossum and horses are commonly e/posed to the parasite in regions the opossum is $ound+ 6s
a matter o$ $act1 pre#elance $or the disease among horses li#ing in those regions is o$ten -
percent or higher+
Chen testing $or the disease1 #eterinarians o$ten do so &ith baited breath+ 'ertainly1 there is no
de$initi#e test $or the disease8 meaning there is no test &hich can conclusi#ely determine that a
horse has EPM+ 0ather1 there is a combination o$ symptoms and tests that assist a #eterinarian
in declaring that a horse has the disease+ Ho&e#er1 no diagnostic test is per$ect and it is critical to
understand ho& sensiti#e or speci$ic a test might be to better understand &hen a test result is
true or $alse+
Chen testing $or EPM1 your #eterinarian &ill ta2e a sample o$ your horse@s cerebrospinal $luid
(')?" so that a &estern blot assay can be per$ormed+ Preliminary research suggests that this
particular test is GF percent sensiti#e and GF percent speci$ic $or the diagnosis o$ EPM+ (ut again1
it@s not per$ect1 and #eterinarians are o$ten as $rustrated as their clients &hen it comes to
determining &hen a H$alse positi#eI or H$alse negati#eI might be indicated rather than ha#ing an
accurate result+
5t@s also important to understand the di$$erence bet&een sensiti#e and speci$ic+ )ensiti#ity and
speci$icity describe the rate o$ $alse Opositi#e and $alse9negati#e test results+ )ensiti#ity is the
proportion o$ truly diseased animals that test positi#e1 &hereas speci$icity is the proportion o$ non9
diseased animals that test negati#e+ 5n other &ords1 the &estern blot assay can determine GF
percent o$ the time &hich animals are truly diseases and &hich animals are not+
?alse test results1 &hether positi#e or negati#e1 can occur $or a number o$ reasons1 &hich can be
bro2en do&n into $our broad categories: problems &ith the biological mar2er that is measured by
the test1 di$$erences among indi#idual patients1 problems &ith the testing procedures+
Diagnostic tests are meant to identi$y some characteristic or mar2er o$ a disease that is not $ound
in healthy animals+ 6n ideal mar2er o$ a disease &ould be $ound in e#ery a$$ecti#e animal early in
the disease process as &ell as throughout its entire course1 and it &ould ne#er be $ound in
una$$ected animals+
Ho&e#er1 no mar2er o$ disease is per$ect and some tests identi$y general mar2ets1 &hereas
others are designed to detect mar2ers o$ #ery speci$ic diseases+
?or e/ample1 you may ha#e the $lu1 but it &ould ta2e a speci$ic test to determine &hat 2ind o$ $lu
you had1 &eather it is 6sian1 Hong <ong1 0ussian1 etc+ Mar2ers1 &hich identi$y on generalized
disease state1 may not be help$ul &hen symptoms can be caused by many di$$erent conditions+
5n addition1 patients di$$er and some healthy animals may e/press mar2ers $ound in diseased
animals+ Chile some diseased animals may not e/press mar2ers1 other diseased animals do+
Depending on the stage o$ the disease1 mar2ers &ill or &ill not be e/pressed+ ?or e/ample1
clinicians ha#e reported that horses in the #ery early stages o$ EPM may not ha#e detectable
concentrations o$ antibody in the ')?1 but they &ill be positi#e i$ retested a &ee2 or t&o later+
6nother problem is that occasionally the ')? sample1 &hich is a &atery substance1 may be
contaminated &ith blood causing a $alsely ele#ated )+ =eurona antibody concentration+
6nd $inally1 it ta2es some s2ill to per$orm these tests accurately and the #ariability in s2ill and
diligence can easily a$$ect results1 as is true o$ any technical tas2+
Chile it is not possible to be : percent con$ident o$ the disease status o$ any animal1 it is
possible to compare test results &ith that o$ a population o$ animals1 &hich truly ha#e the disease+
,hat1 combined &ith the symptoms the horse might e/hibit1 usually gi#es the #eterinarian a high
rate o$ accuracy &hen diagnosing the disease+
?urther research is needed to determine the accuracy o$ speci$icity and sensiti#ity $or the &estern
blot assay1 ho&e#er1 this test has been used e/tensi#ely in the past $or the diagnosis o$ EPM and
a#ailable in$ormation suggests that it is highly sensiti#e and highly speci$ic+ 5t &ill not1 ho&e#er1
be use$ul &hen used in horses in &hich the disease pre#alence is #ery lo&1 and there$ore1 should
not be used in horses1 &hich appear normal+
Dr. Paul Morley is an assistant professor in the Department of Preventive Medicine at the Ohio
State University in Columbus, Ohio. urther information on !PM can be obtained from "he Ohio
State University at http# $$prevmed.vet.ohio%state.edu$epm+
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Phone: G-F92!!9:;A Q ?a/: G-F92!!9:FBG
posted: B4:B422+ 7ast updated: G4242-