I hear stories often and have had experiences myself where one vet will say EPM, and a second opinion will not. Or something like and I kid you not "we separated my horse off by himself and he would run the fence...we knew something was wrong..its EPM". It seems that for every behavioral or performance issue this condition is slapped on. I know that it is very real and can and has caused serious issues and death in many horses. What I am addressing specifically are horses that do not show symptoms or show very mild ones that may or may NOT be EPM.

The field test for this also seems easy for a lot of  horses to maybe not react the desired way...

Then there is the issue of the titer test. Lets say 80% of horses are exposed to the disease but in 90% of those cases their immune system fights it off... however their blood test is still going to test positive for titers..correct? We are talking about a test result that can resolve a potential sale in an instant. People are scared to death of it.

I guess the bright side is that there are treatments that are super affordable and easy to administer so if you even slightly suspect it, you can treat them to ease your mind.

Still...what a frusterating condition based on all stated above.

Yeah I do. I think it's a tricky disease to diagnose for the reasons you stated above. The titers alone aren't black and white. Ideally, if you really want to know, you would do paired serum and CSF titers and repeat them again over time, maybe after treatment, etc. But it comes with risks to sample CSF and again like you said, titers just show exposure, so many clients opt to just treat out of precaution because its cheaper to just treat and see response to therapy than it is to send off the diagnostics and then treat.  Still to this day the only definitive 100% diagnosis of EPM is a necropsy with the organism identified in the CSF. 

And yeah doing a neuro exam isnt perfect either. There are definitely times when you can see ataxia and proprioceptic deficits, cranial nerve deficits, etc... but there are other times when you question whether the horse is just being cooperative (crossing the legs) and will just let you do it. So, it takes a lot of interpretation to really figure out with the mild cases or cases that also have lameness components.  moderate to severe cases can be easy to figure out. 

I would never send blood off for EPM titers on the basis of a pre purchase. That just seems to be 1- unrealistic for the buyer and 2- extremely hard to interpret in the light of an asymptomatic horse in a PPE situation.  That's a mess I would not want to be involved in.  

I've also had multiple horses come in for workups because either trainer owner or friend or whoever suspected EPM... my favorite one was a colt that was barely started and the trainer complained he was behind for what she wanted, which I felt her expectations were too high for this particular horse at his stage of training, and wanted owner to test for EPM.. Horse comes in temporarily blind in one eye from uveitis. Well yeah I guess I can see why he was acting funny, unwilling, and weird to the right when his right pupil was 100% shut from inflammation. 

But, keep all this in mind, with all this that I know, I'm currently finishing a 30 day EPM treatment on one of mine who I'm at a point of desperation with, although she did look slightly ataxic in the back end.. but, yeah I didn't do any blood tests I just went with the "treat and judge response" method.  

I know of a lady whose horse was diagnosed with EPM. But treatment did nothing. They were advised to put him down. Vets said he had neurological damage but where/what, they weren't sure. This was a several years journey for her. She is a movement science specialist and very well known in the tech world. She started using movement science, pain science, self determination theory with CLA  and positive reinforcement. Kinda just did a huge paradigm shift and horse training experiment. You wouldn't believe the moves this little Icelandic gelding can do now at 19 years of age. She was top 10 in the US in some tolt  class/division she competed at. What she does is mind blowing and she will tell you it is not for everyone and she is right. But what a turn around her horses have made. So maybe it is, but she will tell you she is glad she did the treatment twice because she was able to move on.

I wish more people started treating for epm as their first step. I have bought and had client horses in that I had to treat because they never treated them and just overlooked their problems or associated them with being behavioral. It is stressful on the horse and rider when you miss that. I have only ever sent blood twice. I think it is a waste of time and money. Treatment wont kill them and I havent had a horse yet thats went through an epm treatment and not have something change about them. Whether it was gaining weight or muscle soreness went away.

yes epm meds can kill! There has been some cases that horses have died from treatment.  Horses are not invincible.  They can have reactions to anything just like people.  I agree with you on how EPM meds can help. and should treat but you are still taking risks with any meds you give to horses.  But majority do tolerate EPM meds fine.  thank goodness!!!!

This is true. Never say absolutes with horses because you will have one that proves you wrong.  They are typically well tolerated in most horses, but especially when considering compounded formulations (which TONS of horses are treated with EPM via compounded drugs and not the FDA approved drug due to cost), mistakes can happen.  

I went with my father in law two days ago to have a horse with a buckling hind leg checked out (and I am talking not even every ride). He associated it with being lazy but wanted to make sure for peace of mind. We took him to a very well known vet who has a very good reputation. He instantly did neurological testing and I watched the horse fail several tests. This is a horse you would never suspect anything like that from. He does 3 tests for neuro symptoms - x-rays the neck for wobblers, runs blood for EPM (they run it twice), and runs blood for Vitamin E levels. He thinks the horse just has low Vitamin E but EPM is a possibility (we ruled out wobblers). If the horse has the EPM titers he will go back in for a spinal tap to test for actual levels. Yes, I think SOME vets do say EPM very quickly, and some people just treat for EPM if they notice anything is off. I personally like definitive answers and test results though (but I think some try and take a more affordable route). 

Yes! Horses are exposed if they are outside and probably through hay even if they never spend a day in a pasture. The organism that causes EPM is so prevalent in nature it's pretty much impossible to isolate your horse from it. I've seen vets diagnose with -0- tests run and just sell the marquis, or whatever treatment, either for the $$'s or feel good for the owner. Which is how we ended up with antibiotic resistant bacterias. 

I cant even believe how often it happens!!

I understand wanting definite answers but please look up what a spinal tap does to horses.  Not saying you shouldnt do it but be sure to ask the risks.  There is more to it than just pulling fluid out, If I remember right it also wil lose compression and sometimes it doesnt build back up in the spine.  Not sure how to explain it. 

What are your thoughts on compounded medicine for the treatment of EPM?

Had three vets out today to watch me ride my gelding. We are going to go ahead and treat with Protazil for EPM. I brought up the compounded route and all three said absolutely not. ??‍??

Lol, its like Covid.

And when treated if the horse had symptoms.....do they go back to being able to be competed on?   Do they require constant maintenance to keep them healthy and sound?

I had a horse that got sick in 1993. Could figure out what was wrong.  I had a very good vet and she did a lot of reading and figured it out. No one knew what it was. There was no medicine for this at the time. I finally found someone who had a little knowledge of EPM and she told me she had given her horse a medicine for humans. My vet got a prescription for it and I started the horse on it. Horse did get better. About two years later five horses in my area died from EPM. The owners got together and found the common factor which was that they shared was that they all bought feed from the same feed mill. Since then I have several friends who had horses diagnosed and within 5 days the horses were dead. I have had about 5 horses that I know had EPM. One weanling was diagnosed with colic but I knew she had EPM so I contacted another vet and got EPM meds for her. I was really kind of surprised that the vet called it colic. I know my own horses well enough to tell if it is EPM or not. I will say a few things. The treatment for EPM has greatly improved on the past few years. Vitamin E helps a lot in rehabilitation. It appears that horses can have a mild, moderate or severe case of EPM and it doesn't necessarily progress from one to the other. If a horse has a severe case they probably will not last a week. Yes, they can come back from a mild case, maybe not a moderate case. Will try to link a pole run at the APHA World Show. Sweet boy was so body sore he could barely go. This horse was pretty sick at the time and probably has had seven treatments over the years. I lost track. Like I said I know my horses well enough that I can tell if they have EPM. 

https://m.youtube.com/watch?v=HYhRCoi0U-A

My 21 YO retired multi World/National champion gelding is still standing after EPM treatment. He, however, has an extremely weak hip/rear leg and wobbles a bit walking.  However, his eyes are bright, he eats well, still manages a little buck and snort and seems happy. He is also able to get up after rolling around.  So....we are letting him tell us when it's time to go. He had three treatments. Did they help?  He went through a terrible period at first when we were ready to put him down, then he rallied and got to this 'stable' point. I do think EPM is blamed for lots of issues these days and it also seems I am seeing lots of kissing spine discussions now, too. There are certainly 'trends' in the horse world -- just look at tack!  LOL!