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> It has been estimated that 65% of the horses in the Southeastern US will
> have a positive blood test for EPM. Clearly 65% of the horses in the SE
> don't have EPM.  When my horse came down with West Nile, the vet did
> some coordination test on the horse. He diagnosed it as WN. He said it
> would be (with a high probability) one of three things, an injury , EPM
> or WN. He eliminated EPM and an injury with the coordination test. He
> was right.
On the other hand, depending where you live, a significant number DON'T have
titers to EPM.  So if you do a blood test and it is negative, you know that
the horse does NOT have it.  The blood test is cheap and has no more risk to
the horse than any other blood draw.  But if your horse is one of the ones
that has NOT been exposed, there is no need to proceed any further.  I would
not even consider having a spinal tap done for EPM on a horse unless I had
first drawn blood and gotten a positive.  And even if you don't do the
spinal tap, once again a negative blood test will indicate that one had
better look in another direction for a diagnosis, whereas a positive is just
one more clue that the neurological symptoms could indeed be EPM.

Also, I don't share Truman's confidence that EPM and an injury can always be
distinguished by neurological symptoms alone.  EPM can be extremely
variable, depending on where along the cord the organism is attacking, and
injuries can also be quite unique in their presentations.  Separating the
two on clinical presentation is always an educated guess at best, but the
educated guess may be as far as you want to go, given economics or other
factors.

Regarding Stephanie's comments about spinal taps--I just went through two in
late April.  And it turned out that I had bacterial meningitis, which could
have become life-threatening had I not had the first one done, and if we had
simply fiddled around trying to control the excruciating pain, assuming it
was the flu--which would have been the most common situation to fit my
symptoms.  As it was, we caught it early, and were able to initiate
treatment before symptoms became too severe.  I opted to have the second
one, simply because we were unable to culture the organism in the first one
(just had major white blood cells and other changes indicative of a response
to a bacterial infection in the spinal fluid), so needed to have some
measure by which we could judge response to treatment.  I still have a stiff
back, but it beats being dead, and it's improving daily.  I'm not real keen
on the procedure--but never say never, because there is a time and a place
for every diagnostic procedure.

Heidi


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