Uncovering the gray areas of EPM
That said, some risk factors and prevention strategies have been unveiled. Good news, right? Unfortunately, much of the information that's been discovered about EPM has served only to generate more questions, and many practitioners feel less knowledgeable about this disease now than they did five years ago.
Clinical signs of severe or advanced EPM are relatively straightforward and easy to see, including asymmetrical muscle loss, varying degrees of weakness and ataxia and even recumbency. Evidence of early, low-level EPM, however, can be so insignificant or subtle that it's often overlooked. Practitioners often depend on clients noticing small physical changes in their horses [musculature, posture, gait and impulsion] or minor unexplained changes in personality or behavior (Photo 1, p 2). Additionally, signs of EPM can mimic those of several other neurologic diseases or health conditions.Moreover, methods of EPM diagnosis have been shown to be problematic and often inconclusive, so clinicians are often left using a "better safe than sorry" strategy—that is, when in doubt, assume its EPM. This means some unaffected horses may also be treated, and other conditions may be missed. But response to treatment seems to be the best diagnostic tool currently available. Treatment options vary, and a number of drugs are available, but there's little consensus as to the absolute best product.
EPM cluster outbreaks
It now seems that cases of EPM are not as isolated as we originally thought. "EPM has traditionally been reported as a sporadic disease," says William J.A. Saville, DVM, PhD, DACVIM, Department of Veterinary Preventive Medicine at The Ohio State University College of Veterinary Medicine. It was thought that particular aspects of the immune system and environmental stressors led certain individual animals to develop the disease, while most other horses did not.
While this remains true in most instances, Saville has identified cases of EPM cluster outbreaks where multiple horses in the same area or on the same farm have developed the disease, which seems to imply that all horses, if exposed to the right combination of stress and environmental factors, can develop EPM. "There are reports of EPM cases in Panama in which all affected horses were stabled at the same location, and also a report of an outbreak on a farm in Kentucky," he reports.
At a horsemen's camp in Orinda, Calif., a number of horses developed EPM in 2010. According to an Orinda Horseman's Association (OHA) news release, EPM is diagnosed in less than 0.5% of horses annually in the United States, and more than one case is seldom seen at a particular farm.1,2 That said, the news release goes on to describe OHA pastures as hot spots for EPM. "In sharp contrast to the [national EPM] incidence mentioned above, four horses out of a herd of 36 on the OHA pasture (11 percent of the total population) have been diagnosed with EPM just in the last year," the report noted.1