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  Discussion on Proprioceptive Deficits
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New Member:
beddyh

Posted on Thursday, Aug 5, 2010 - 10:41 pm:

I am trying to help a friend care for and diagnosis 2 year old horses. One mare, and one gelding. Both are showing neurological symptoms, graded 1/4 on the front, 2/4 on the back (mare)and 2/4 in the front and 3/4 in the back respectively.
The gelding who is the worse of the two swings his rump back and forth like a waddling duck. He has major swaying in the trunk. Has had radiographs which are inconclusive, as well as, a myelogram which is inconclusive and neither show signs of wobblers.

It was diagnosed as Equine degenerative myopathy and both were put on 10,000 units vitamin e daily. After 6 weeks on vitamin e there has been no appreciable change and everyone is stumped.
I have spoken to some vets who seem to feel there is Dorsal root damage from an undetermined cause.
EDM, EPSM, Wobblers, and EPM have all been ruled out through blood work and CSF analysis.

I am wondering if we are all missing something! There does not appear to be any cranial nerve deficits, no changes in behavior, or appetite.

The colt has good days and bad days and seems to tire quite easily. He does quite well until he gets tired.

They are both on good quality pasture of Alfalfa/Timothy and soaked Timothy cubes for the vitamin E.

If we can diagnose the worse of the two maybe there is help for the other who has not progressed so rapidly.

Thank you for your help

PS: They were both put on 5 days of bute in order to determine how much of the deficit was caused by inflamation and it didn't seem to help much. Can you tell me if it is worth trying dexamethazone as an anti-inflammatory as I know it is quite a bit stronger.

Thanks again
Member:
scooter

Posted on Friday, Aug 6, 2010 - 10:22 pm:

Is it possible since you have ruled out best you can internal forces that they could possibly be eating something in their pasture or hay causing this? Are they pastured or stabled? are they kept together and receive the same diet? If so maybe completely changing their environment might help rule it out anyway. Some weeds have strange effects on horses, or anything poisonous in the environment you may not be aware of.

Did they both start symptoms at about the same time? It would seem the odds would be against both of them having the same thing physically wrong with them at the same time, without a common denominator.

Hope you find the answer
Moderator:
DrO

Posted on Saturday, Aug 7, 2010 - 7:44 am:

Welcome Becky,
I would like to know the cellularity, color, and protein content of the CSF. Also are these two horses related? Has there been any weight loss? The fact that two are effected strongly suggests a infection, toxin, or nutritional deficiency.

Viral encephalitides including the neurological forms of E Herpes V sometimes present with incoordination as the prominent sign. Have they been thoroughly examined for ticks about the head and neck? Tick paralysis has been reported in livestock though rare in horses.

The worsening with exercise is suggestive of botulism, though I would have expected some cranial nerve deficits. Also I would note that EPM is sometimes caused by organisms other than Sarcocystis so will not show up on standard lab work. For more on this see the article on EPM.
DrO
New Member:
beddyh

Posted on Saturday, Aug 7, 2010 - 12:21 pm:

Thank you both so much for your help. I will try to answer both questions together and hope it is not too confusing.

We have thought of environmental causes so have moved the horses onto a completely different piece of land since the onset of the symptoms. The property they are on has had no animals on it, and has been used by the owners as hay land for 10 years. No chemicals have been used at all.

They are pastured together and are on the same diet. Up until the move their diet was straight timothy hay with a 12% complete feed for breakfast and dinner.

The two horses are half siblings with the same sire. There has been no weight loss and they both have very good appetites. Other than tiring easily and the proprioceptive deficits are happy and comfortable.

They have been tested for EHV through blood work and titers and it has come up negative.

Also, the symptoms were very insidious and we are not sure when they began. We have been hunting for a solution for almost 12 weeks now and my suspicion is that the proprioceptive deficits were subtle but there for at least 3 months before being nailed down.

Would botulism progress that slowly?

They have not been examined for ticks, however will do so know. Would it be as slowly progressive as this has been?

Will get the CSF results and post ASAP.

Also, is it worth trying the dexamethazone to rule out inflammatory symptoms?

Thank you so much for your time.
New Member:
beddyh

Posted on Saturday, Aug 7, 2010 - 12:26 pm:

Oops, one more thing. The horses are pastured together. We have tried stalling them overnight, in the hopes that the rest would help and it appears to make them lethargic. So, they are kept together outside in a large pasture in the daytime and a smaller pen at night.
New Member:
beddyh

Posted on Saturday, Aug 7, 2010 - 12:28 pm:

Oops, one more thing. The horses are pastured together. We have tried stalling them overnight, in the hopes that the rest would help and it appears to make them lethargic. So, they are kept together outside in a large pasture in the daytime (5 acres) and a smaller outside pen (1/10 of an acre) at night.
New Member:
beddyh

Posted on Monday, Aug 16, 2010 - 2:41 pm:

Here are the results of the CSF

Colorless
Clear

WBC <1.0 10*6/L
RBC 19.0 10*6/L
CSF Protein .51 g/L
Glucose 3.07

The Description is as follows:

The cytocentrifugation and direct smears prepared from the submitted fluid sample demonstrate a low number of intact cells with total number of nine nucleated cells counted. Four of nine cells are small mononuclear cells/lymphocytes. Two of nine cells are large mononuclear cells. Two of nine cells are nondegenerate neutrophils and one cell is an eosinophil. There is no evidence of any foamy macrophages nor of any microorganisms. Five disrupted/lysed nucleated cells were observed and unfortunately, their origin cannot be completely determined. Occasional anucleated keratinized squamous eqithelial cells are present (consistent with contamination). Low number of intact rhomboid cells are present.

Microscopic findings: nucleated cell count and protein content, as well as cytologic finding are within normal limits at this time.

As stated above, the nucleated cell count and the protein content are within normal limits at this time. Also cytologically, the fluid is within normal limits. Presence of a higher red blood cell count and the presence of low numbers of intact red blood cells cytologically may suggest the presence of a mild amount of blood contamination within the sample, which may also explain the presence of the low number of neutrophils and the single eosinophil. Based on the appearance of the disrupted cells, my guess would be that they are of small mononuclear origin; however, I cannot completely confirm this. There is no evidence on cytology of any dysplastic or atypical nucleated cells nor of any microorganisms.

I hope that helps and again would like to thank you for all your help
Moderator:
DrO

Posted on Tuesday, Aug 17, 2010 - 7:49 am:

I think with such a normal CSF fluid you have to move CNS infection and trauma to the bottom of the list and consider more peripheral nerves, possibly neuromuscular junction diseases, and even muscular weakness.

There have been posited that there are some poorly defined clostridial toxins that create diseases the do not behave like the well established clostridial diseases, Grass Sickness comes to mind. Though not classic for EMND check out HorseAdvice.com » Diseases of Horses » Nervous System » Incoordination, Weakness, Spasticity, Tremors » Equine Motor Neuron Disease (EMND). It provides a relevant list of rule outs and further diagnostic steps.
DrO
Member:
beddyh

Posted on Wednesday, Aug 18, 2010 - 9:58 pm:

Thank you so much Dr. O. We are going to rule out all the things listed in the article. Wish us all luck, and we will keep you posted
Member:
beddyh

Posted on Monday, Sep 6, 2010 - 12:47 pm:

• botulism
• chronic organophosphate toxicity
• myositis, tying up, shivers (equine polysaccaride storage myopathy)
• malabsorptive disorders
• grass sickness (is this the same as botulism?)
• ionophore poisoning
• selenium deficiency or toxicity

The attending veterinarians believe they have addressed the issues above. All testing is inconclusive and they are recomending necropsy as they say there is nothing that can be done.

The colt is still not showing any sign of cranial nerve deficit or depression so it is a heartbreaking decision.

Is there anything else you could suggest as the filly is starting to go down hill as well.

Thank you so much for all your help.
Moderator:
DrO

Posted on Monday, Sep 6, 2010 - 9:58 pm:

Beddy,
How have they excluded each of the above?
DrO
Member:
beddyh

Posted on Monday, Sep 6, 2010 - 10:34 pm:

Hi Dr. O. I think they have based the desicion on the blood work they have already done and the lack of other symptoms. They seem very confident that they can't do anything.
New Member:
mdelton

Posted on Tuesday, Sep 7, 2010 - 12:46 pm:

Beddy,

Very sorry to hear about the two young horses. If they are turned out together and not related, then perhaps they both got into the same "contaminant" in the pasture. Here is my story that relates to yours.

I have a 4 yr old gelding that showed similar symptoms last Nov/Dec. My horse went to Cornell for a month where he was Cat scanned, CSF drawn and tested for many diseases...all neg. He did have eosinophils in the CSF and the vets concluded by process of elimination, that he most likely had a aberrant worm migration to the cerebellum forming a lesion (too small to see on CT).

We are in Western NY and have a lot of deer that roam in the pasture. So one of the suspects was P. tenuis. I was told that necropsy was the only way to know for sure. Since the horse is not unsafe to be around and is dealing with his ataxia fairly well, we did not euthanize. Hard to say if he is getting better or just getting better at dealing with his disability. I was also told that lesions in the cerebellum do not heal.

I wish you luck in determining what is going on in your horse's cases. Believe me, I know how hard it is to deal with.

MaryD
Moderator:
DrO

Posted on Thursday, Sep 9, 2010 - 5:06 pm:

Well Beddy,
Without a likely diagnosis for a disease process you are left with empirical therapy:
1) antibiotics
2) steroids
3) vitamin supplementation
4) ?
It is not clear that any of these will be of benefit but are better than doing nothing at all.

Has a referral to a equine neurologist been considered?
DrO
Member:
beddyh

Posted on Monday, Sep 13, 2010 - 1:42 pm:

Hi Dr. O. I have just recieved copies of all blood work, labs, etc.

EDM - Vitamin E levels are within normal range but.....

Have noticed that the horse has iron stress, serum level is 54 and reference is 17 - 37.

From what I understand iron, not only, causes catastrophic free radical damage but also inhibits the absorption of vitamin E.

Any idea of a detoxification for this?

EPSM

There also seems to be a myopathy in the ast/cpk levels. Neither is tremendously high but AST is consistently higher than ck.

AST level is 558
CPK level is 512

If what I am reading is correct this is suggestive of a muscle myopathy, or recovery from tying up.

I am also noticing symmetrical muscle waste in both the neck and bum. They are very tense and tight in the back and seem to be compensating by humping up in the back.

This seems suggestive of EPSM.


Viral...

The latest blood work also says he has mild lymphositis.

Neutrophils 39%
Lymphocytes 56.3%
Monocytes 2.6%
Eosinophils 1.8%
Basophils .3%

Immune stimulation/viral

EPM...

EPM weakly positive in blood serum but not CSF( Western blot)I am finding that western blot in csf has false negatives in immune comprimised horses. So.......symptoms of everything all over the map. He has had two tests for Sarcocistis, approximately 2 weeks apart. First one negative and the second weakly positive.

He has had a neurological assesment done and am forwarding all correspondence to several neurologists.

Please let me know what you think and if you can decipher any more out of the above. As, at the moment am trying to wrap my head around how to treat all of the above.

Again, can't thank you enough for your help!
Member:
beddyh

Posted on Monday, Sep 13, 2010 - 2:41 pm:

Also forgot to mention that Fibrinogen is high

Coagulation 4 and Reference range is .5 - 4

Thanks again
Moderator:
DrO

Posted on Monday, Sep 13, 2010 - 7:53 pm:

What are the units for the iron stress(?) reading and what is the fibrinogen level? Note that iron toxicity is very unlikely in the adult horse. Short of iron injections given to neonatal foals, iron toxicity is essentially unreported problem in the literature. For more see HorseAdvice.com » Horse Care » Equine Nutrition, Horse Feeds, Feeding » Minerals and Electrolytes for Horses, an Overview.

Neither do I don't find any of the other labs compelling. See the articles on each of the individual diseases you mention for more on interpretation.
DrO
Member:
beddyh

Posted on Monday, Sep 13, 2010 - 10:04 pm:

Hi Dr. O, the units of iron are 54 umol/l and his fibrinogen is 4 g/l
Member:
beddyh

Posted on Monday, Sep 13, 2010 - 10:17 pm:

Hi Dr. O I read in you article on Iron under the nutrition section

"Iron toxicosis •Excess administered, especially serious if vit. E def & in foals. "

Due to the liklihood that it may be EDM I was wondering if there is a way to ensure that we remove/and avoid excess iron. This may aid in absorption of the vitamin E?

Thanks again!
Moderator:
DrO

Posted on Wednesday, Sep 15, 2010 - 6:50 pm:

The only method I know of lowering iron levels in the diet is to feed foods lower in iron. Considering the variability of iron in most forages that would mean testing your current forages and then looking for forages low in iron.

Trace mineral salts often contain iron in small amounts but I would not consider discontinuing this source as you also will be cutting back on other important nutrients that and I do not see how this may be involved with your your problem: iron toxicity exhibits as liver disease/failure and not as a vitamin E problem. The reason low amounts of vitamin E potentiate toxicity in foals is that the E probably helps ameliorate the damage done to the liver by the iron.
DrO
Member:
beddyh

Posted on Wednesday, Mar 16, 2011 - 6:52 pm:

Hi again Dr. O. it has been a little while! This is were we sit with the two youngsters.

We have put them both on a low carb and low sugar diet designed by an equine nutritionist, as well as 20,000 units of natural vitamin E and Recovery EQ.

The colt who was initially the worst has improved to almost 80 -90% full function! What good news!
The improvements started approximately 3 days after we began soaking the hay in order to remove the sugar and he has improved steadily since.

He is still having some trouble with his stifle which was the very first symptom.

Now, almost 7 months later the filly is going steadily down hill. It all started with a hitch in her stifle just like the colt.

She has progressed quite slowly, the same as the colt to a 2/4 in the front and 3/4 in the back. And she is also waddling like a duck.

This has absolutely stumped a number of vets and both myself and the owner are incredibly confused.

Any ideas? We would sure appreciate it.

Thanks so much!
Moderator:
DrO

Posted on Friday, Mar 18, 2011 - 12:09 pm:

Hello Beddyh,
I am sorry to hear that things are not well with the filly. Has the working diagnosis been EDM, the colt's response is suggestive that this may be the problem. If this is so then it sounds like this filly's problems with vitamin E and oxidative stress is much worse than the colt's. The prognosis for complete recovery is poor in all individual and it would not be surprising that some don't respond well at all.
DrO
Member:
beddyh

Posted on Friday, Mar 25, 2011 - 11:32 am:

We have been working under the assumption that it could be EPSM rather than EDM. The diet is designed as nerve friendly and low in carbs.

The vet was here again and suggested that there is compression in the cervical spine however, it does not appear on standing rads, or myelogram? What are the chances that there is a compression that could evade testing. I assume it would have to be a dynamic compression rather then static. Am I correct in assuming that?

Could it be the TMJ joint or Vertabral Osteomyelitis?

Would there be a chronic fever if it was an infection that caused the Osteomyelitis?

The fillys' temperature has always been on the high side of normal at approximately 38.3?

We are going to try rest and anti-inflammatories for a few months and see if they respond to that.

They have been allowed to run and buck and play since this all began and I am beginning to think we should have minimized added trauma since the beginning.

Wow, if nothing else we have learned a tremendous amount and I cannot thank you enough for all of your incite!
Moderator:
DrO

Posted on Saturday, Mar 26, 2011 - 4:41 pm:

Hello Beedyh,
The problem is from where I sit most anything seems possible. But TMJ seems very unlikely. Any disease of the vertebrae that results in pressure on the spinal cord can cause ataxia including osteomyelitis.
DrO
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