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Equine Protozoal Myeloencephalitis

By: Dr. Philip Johnson

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The prognosis for horses with EPM is variable. Although early diagnosis and prompt therapy help to ensure a good response, irreversible damage to the brain or spinal cord is more likely to occur if the parasite has been present for long periods of time.

Most horses improve with treatment, but relatively few make a complete recovery. Some horses do not respond to treatment at all, and without treatment, many horses eventually deteriorate to the point that they are unable to stand up. A significant number of horses eventually relapse and develop further active EPM.

  • Approximately 10 to 20 percent of treated horses might make a full recovery
  • Approximately 10 percent of treated horses do not respond and are euthanatized
  • The remaining 70 percent make various degrees of partial recovery

    Some have suggested that 70 percent of EPM-affected horses can return to their original level of work upon completion of treatment.

    If treated horses do respond favorably, it appears that they may still be at risk for recurrence of EPM (relapse rate is higher for horses that have been treated for less than three months). The reason for relapse is unknown. Possibly, the anti-protozoal treatment fails to eliminate the parasite but allows the immune system to suppress the parasite. If the immune system is compromised again in the future, further EPM symptoms may develop. Alternatively, for whatever reason the individual horse developed EPM in the first place, there might be an underlying inherent predisposition to this disease that enables the same horse to become affected if challenged again in the future.

    Early diagnosis and prompt therapy help to ensure a favorable response. If the horse does not respond to treatment, it is appropriate to also re-consider other possible neurological diseases. If improvement is not noted after four to six weeks of therapy, the prognosis for recovery is relatively poor.

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