The problem is that EPM treatment is very cost prohibitive. In general, $800 to $1500 for a month of treatment with Marquis or Protazil. A cheaper alternative, Rebalance is still around $300 a month.

If I understand it correctly, the blood test will often come up positive in certain areas, which is why pairing a positive spinal tap with a positive blood test is more definitive for an active case of EPM. I would think that would be better than giving medication, since it is so expensive to treat.

I personally would want a much more definitive diagnosis since stumbling could be so many things. It could be a hoof problem, arthritis in the back or neck, a vitamin E deficiency, etc. I would want an extensive workup that showed definitive neurological signs and also ruled out other causes of lameness or stumbling. If there were multiple neurologic signs, then I'd go for the blood test and spinal tap.

Here is a list of signs of EPM:

 Ataxia (incoordination), spasticity (stiff, stilted movements), abnormal gait or lameness.
 Incoordination and weakness which worsens when going up or down slopes or when
head is elevated.
 Muscle atrophy, most noticeable along the topline or in the large muscles of the
hindquarters, but can sometimes involve the muscles of the face or front limbs.
 Paralysis of muscles of the eyes, face or mouth, evident by drooping eyes, ears or lips.
 Difficulty swallowing.
 Seizures or collapse.
 Abnormal sweating.
 Loss of sensation along the face, neck or body.
 Head tilt with poor balance; horse may assume a splay-footed stance or lean against stall
walls for support

 

The problem is that EPM treatment is very cost prohibitive. In general, $800 to $1500 for a month of treatment with Marquis or Protazil. A cheaper alternative, Rebalance is still around $300 a month.

If I understand it correctly, the blood test will often come up positive in certain areas, which is why pairing a positive spinal tap with a positive blood test is more definitive for an active case of EPM. I would think that would be better than giving medication, since it is so expensive to treat.

I personally would want a much more definitive diagnosis since stumbling could be so many things. It could be a hoof problem, arthritis in the back or neck, a vitamin E deficiency, etc. I would want an extensive workup that showed definitive neurological signs and also ruled out other causes of lameness or stumbling. If there were multiple neurologic signs, then I'd go for the blood test and spinal tap.

Here is a list of signs of EPM:

 Ataxia (incoordination), spasticity (stiff, stilted movements), abnormal gait or lameness.
 Incoordination and weakness which worsens when going up or down slopes or when
head is elevated.
 Muscle atrophy, most noticeable along the topline or in the large muscles of the
hindquarters, but can sometimes involve the muscles of the face or front limbs.
 Paralysis of muscles of the eyes, face or mouth, evident by drooping eyes, ears or lips.
 Difficulty swallowing.
 Seizures or collapse.
 Abnormal sweating.
 Loss of sensation along the face, neck or body.
 Head tilt with poor balance; horse may assume a splay-footed stance or lean against stall
walls for support

Agreed that the stumbling could be many things. She has been working alongside her vet and farrier closely to see if it was a hoof problem and that does not seem to be the source of the issue. The horse sees a regular chiro and he has not shown any abnormal soreness/changes in the neck or back(he is also 8YO). He also gets glucosamine injections and a vitamin E supplement. He has recently started a head tilt to the right under saddle. His teeth have been checked and are done annually. He also has had his saddle professionally fitted.

The vet has done a type of neurologic test where you turn and pull on the tail to watch the horses' coordination and he passed that. Obviously, this is just a baseline and is not a great test for EPM/neuro issues.

Thank you for your input, though. It is greatly appreciated!

 

My horse had EPM....
My vet had the experience and sadly the knowledge because EPM is so high a probability & incident level he saw so many cases, and my guy was textbook.
Blood work was done looking for markers of other ailments....as if levels are off of somethings it can produce similar seen as you describe.

I was told minimum of $800, probably closer to the $1200 - $1300 for a one-month treatment and....it may require more than one treatment and can recur as in need treating months later again. The vet suspected we were looking at 3 treatments to get all the organisms....near $4,000.
My horse was very aged, suffering from other issues and we decided to not treat as he had such marked symptoms.....
It was advised to not treat by the vet.
We were told just leave him alone, do not corner yourself in a enclosed space should his balance suddenly be affected, that sort of keep yourself from peril.
My horse was riddled with tumors throughout his guts also and it was those tumors that got him not the EPM, but...BUT....because of his advanced age he was not ridden, no demands put on him other than let me feed you, take care of you, love on you and cherish our days together as long as the animal was able...
When he was truly not doing well, we PTS before he went down and could not get up and that then is a dire emergency to euthanize.

We did not do a spinal tap as it is invasive and ....you better be real good with a needle cause of where you are drawing fluid from.
If this had been one of our younger horses we would of relied on our experienced vet to guide us in treatment and treat we would of done.
On a horse of unknown age but guessed at in their 30's....what were we gaining and what would we lose if not treated...
After he was vet seen he was with us another near 6 months before we said its time as the animal was beginning to truly show decline because of his tumors not from the EPM...it was a sad day but he went out on his terms.

Lord, I loved that horse....even now, months later tears flow...and I swore this rescue was not going to get a piece of my heart....wrong, he stole the entire thing!
🐴....

 

Maybe give the old west holistic EPM super dewormer a shot, it is not a treatment however if there is improvement on it then you could proceed with an actual full treatment?
I did feed it to a mare who someone mentioned they thought she could have it, I didn't think so but there are so many other benefits to feeding it I went ahead and gave it a try. I saw plenty of improvements in her (none that made me think EPM but bodily and mentally she improved). It is a 90 day supply.

 

Join the EPM groups on facebook. There are also cheaper routes for treatment like Oroquin 10 (or it's ingredients) that can be bought online and carefully measured to get the correct dosage. Also many compounding pharmacies have EPM medications.

The main issue with treating EPM is that all the approved treatments define success as improving your horse by one neurological grade. This means if your horse is grade 4 neurological, your horse might improve to a grade 3 by the end of treatment. Owners think that they should have a full recovery given the expense of treatment, but that doesn't always happen. Many horses have to be treated more than once (and for extended periods of time). I think they recommend a prolonged treatment (a couple months) rather than just 14-30 days. Many of the drugs available aren't that effective at killing the protozoa and are only capable of inhibiting the organism from reproducing. This is why you need a longer treatment time.

I know at least one vet that keeps her EPM horse continuously on medication so that her horse will not relapse.

There are many other things that can cause EPM-like symptoms. There's a type of muscular sarcocystitis which can cause muscle issues but is separate from EPM, although treated similarly. And something called polyneuritis equi.

At any rate, it probably won't hurt to treat and see if the horse improves. If the horse fails to improve, you will need further diagnostic testing.

EPM is a rabbit hole. Unfortunately, many people just can't afford to continue treatment for the amount of time it takes to make these horses better. And even then treatment can fail. It doesn't mean it will fail, but sometimes it takes combining medications, ordering different medications, and multiple treatments to get these horses better. It's a very difficult disease, but not impossible to treat.