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for Lyme or equine pro­to­zoal myeloen­cephali­tis. Run­ning sero­logic tests for Lyme and EPM does not help you de­cide if the horse is neu­ro­logic or lame. Just be­cause a lab test is pos­i­tive or neg­a­tive should not af­fect your clin­i­cal eval­u­a­tion.”

Her mes­sage to horse own­ers was to al­low your vet­eri­nar­ian to con­duct spe­cific phys­i­cal tests and take a good his­tory from you, your barn man­ager and/or your trainer in or­der to de­ter­mine on­set of clin­i­cal signs and gait ab­nor­mal­i­ties, when they oc­cur, if they are af­fected by the ad­min­is­tra­tion of NSAIDs, and if they hap­pen all the time or are ir­reg­u­lar in their ap­pear­ance.

“If an ab­nor­mal gait is rec­og­nized, but its ori­gin is not clear, the next step is of­ten di­ag­nos­tic lo­cal or re­gional anal­ge­sia to see if the ab­nor­mal gait will ‘block out’, in which case mus­cu­loskele­tal dis­ease is as­sumed,” said John­son. “If the ab­nor­mal gait is not con­sid­ered ‘block­able,’ in­volves mul­ti­ple limbs, or there are other rea­sons not to per­form di­ag­nos­tic anal­ge­sia, a sys­temic anal­ge­sia trial with phenylbu­ta­zone or sim­i­lar non-steroidal anti-in­flam­ma­tory drug might yield use­ful in­for­ma­tion. Re­peated neu­ro­logic and lame­ness ex­am­i­na­tions are im­por­tant, par­tic­u­larly af­ter anal­ge­sia tri­als. In most cases, the ap­pro­pri­ate di­ag­nos­tic path will be iden­ti­fied at this point.”

John­son re­minded ve­teri­nar­i­ans and horse own­ers that a horse might have lame­ness and mild neu­ro­logic dis­ease. “Some­times it is eas­ier to get rid of lame­ness to see how much that is con­tribut­ing to prob­lem,” she said.

“I re­al­ize there are horses with mild neu­ro­logic dis­ease that are do­ing their cur­rent jobs well,” she added. “Hun­ters, jumpers and dres­sage horses can do their jobs up to a cer­tain point with lowlevel neu­ro­logic deficits. Then if they de­velop lame­ness, it might be be­cause of a new phys­i­cal prob­lem rather than the long-stand­ing, low-level neu­ro­logic prob­lem. That horse might have been that way neu­ro­log­i­cally for years.”

For EPM, John­son said there are vary­ing opin­ions among ex­perts as to the best way to di­ag­nose, treat and po­ten­tially pre­vent dis­ease. “The di­ag­no­sis is based on three prin­ci­ples: com­pat­i­ble clin­i­cal signs with the dis­ease; ex­clu­sion of other dis­eases; and proof of ex­po­sure,” she said. She also re­minded horse own­ers that if the horse gets bet­ter on phenylbu­ta­zone, then it’s not EPM.

She said that cur­rent best prac­tice for di­ag­nos­tic test­ing for ac­tive EPM is for your vet­eri­nar­ian to sub­mit serum and CSF for quan­ti­ta­tive test­ing and cal­cu­la­tion of a serum: CSF titer ra­tio.

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