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  Discussion on Tx for peripheral neuropathy
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Member:
rickityc

Posted on Saturday, Jan 16, 2010 - 10:23 am:

Hi Dr. O,
I have contacted you before on the EPSM board for my 8 yr old QH. I had a biopsy done, sent off to Univeristy of Minn, the results came back negative (as far as I can make out) for EPSM, but Dr, Valberg said that the results resemble a peripheral neuropathy. She suggested checking the serum Vit E and for EPM. I had the serum E done and his results were 230, norm for this test was 200-1000. So, I would consider that a low norm but significant in this case. The EPM was tested a couple of months ago with a good clean CSF sample and it was negative, however the blood test for EPM was positive but this horse lives out 24/7 and no doubt has come in contact with possums, etc.
When I had him on the high fat diet for EPSM he put on weight, especially across his topline, but he actually got MORE lethargic (now I realize that since I was virtually carb depleting him this makes sense if he has a normal metabolism).
He still shifts his weight from hind leg to hind leg, and he just seems very senitive to touch-often swishing his tail and opening and closing his mouth when I groom him.
Two questions come to mind for you. In addition to increased supplementation of the vit E (his selenium was normal and I use a supplement that is pure E-no selenium), is there anything else I can do to help with the peripheral neuropathy?

And, since he never switched weight on his hind legs before the blistering of the stifles, could having that procedure done exacerbated his PN? He still sticks a hind toe a few times a ride and I know I have to continue to build strength in those quads, but when I palpate the stifle area it feels normal and it doesn't seem to illicit any pain.
Thanks so much for your time-Cricket
Moderator:
DrO

Posted on Sunday, Jan 17, 2010 - 12:24 pm:

Hello Cricket, can we have the complete report from Dr Valberg? It may help us answer your question.
DrO
Member:
rickityc

Posted on Sunday, Jan 17, 2010 - 12:51 pm:

Sure, I am going to write it for you because I don't think it would scan well.

Specimen: Muscle for Never Better Magic
Histopathology: Semimembranosus muscle slides stained with H & E, PAS, Gomori's Trichrome, amylase PAS, Oil Red O

There was a moderate increase in variation of muscle fiber sizes. A moderate number of muscle fibers showed anguloid atrophy. A moderate number of muscle fibers showed angular atrophy. A moderate number of muscle fibers had centrally located nuclei. No evidence of muscle necrosis or regeneration was present in the sample. The PAS stain for muscle glycogen revealed mild granular cytoplasmic deposits of PAS positive amylase sensitive material. Blood vessels and connective tissue appeared normal. Oil Red O stain was WNL.

comments: Results resemble a peripheral neuropathy; suggest checking for serum E and EPM.

Most of that is Greek to me even with my medical background. Also remember that Magic's serum E came back 230, normal is 200-1000, and his CSF was negative for EPM.

I went on a ride with some friends Friday and he was great-however we were in new territory and he was really looky. I rode out on our usual trails on the Moss Foundation yesterday and he was lethargic.

Any help in translating that report would be wonderful. Thanks so much-Cricket
Moderator:
DrO

Posted on Tuesday, Jan 19, 2010 - 7:46 am:

Cricket, when muscles loose their nervous supply (we say become deinnervated) they atrophy: become smaller and weaker. I have not heard the terms "angular" and "anguloid" types of atrophy but taking Dr Valberg's statement in context apparently this is a particular type associated with deinnervation atrophy. I believe we can take Dr Valberg's word on this.

There is a disease associated with vitamin E problems even when blood levels are normal which may account for the pathology, lab findings, and symptoms you list above, check out Diseases of Horses » Nervous System » Incoordination, Weakness, Spasticity, Tremors » Equine Motor Neuron Disease (EMND).
DrO
Member:
rickityc

Posted on Tuesday, Jan 19, 2010 - 9:35 am:

Thanks, Dr. O. I have read your info about EMND as well as what Dr Reed wrote in his text book. Consequently I have dramatically increased my horse's vit E supplementation. Guess time will tell. He certainly is putting more topline back on with the increase in work and I think that is a good sign.
Can you think of any reason why having this horse has had such a sudden onset of this problem? I actually think he has had a little something going on nuerologically since I purchased him as a 2.5 yr old, but after he had his sitfles blistered and developed that severe inflammation in the left stifle he has developed these symptoms that he never had before. The vet did use some serious antibiotic therapy on this horse, both IV and IM, to ward off an infection in that stifle-could that have exacerbated this whole neuro thing?
Well, it is what it is now and I will try to vit E and hope for the best. Thanks for your help--Cricket
Moderator:
DrO

Posted on Wednesday, Jan 20, 2010 - 9:23 am:

Current research into EMD is still iffy as to the cause though the disease can be reliably created by feeding very low amounts of vitamin E. A group at Cornell is doing research into this and hopefully they will have more answers for us soon. Let me know how your horse comes along.
DrO
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