Many horse owners facing a possible equine protozoal myeloencephalitis (EPM) diagnosis often discuss with their veterinarian the value of performing a spinal tap to diagnose EPM versus simply treating the disease based on symptoms. A spinal tap is able to provide a titer ratio of serum to cerebrospinal fluid, which will definitively diagnose the disease.
Surprisingly, performing the spinal tap may substantially decrease the ultimate cost for the horse owner, reports The Horse.
Vets who think a horse might have EPM often do one of three things:
- Treat the hosed based on clinical signs
- Treat the horse based on bloodwork, measuring the serum titers against the causative protozoa
- Treat the horse based on serum titers plus a spinal tap
Each of these can be expensive. University of Pennsylvania researchers examined the cost and accuracy of each option for the patients at their hospital and discovered that simply treating the horse for EPM without a definitive test isn't as cheap as it sounds.
Drs. Sarah Colmer and Amy Johnson, both of the PennVet School of Veterinary Medicine's New Bolton Center, conducted a retrospective study of 681 neurologic cases to determine the accuracy and costs of diagnosis and treatment using these three approaches.
PennVet sees mainly sport horses from the Midlantic region. Though the clinic does see EPM cases, cervical vertebral stenotic myelopathy (Wobbler syndrome) and equine degenerative myeloencephalopathy (EDM) are seen more often. The three conditions present in the same ways, so diagnostics are key to determining the best treatment.
Horses included in the PennVet study were ones that underwent a complete neurologic exam, EPM antibody testing on serum and CSF, and neurologic necropsy if the horse was euthanized; 196 horses were euthanized and 23 of them had EPM.
More than 80 percent of horses had positive serum titers and more than 50 percent had positive CSF titers. The scientists say that this shows how common equine exposure to EPM is. The duo used PennVet's prices to estimate the costs for serology alone, CSF centesis (spinal tap) and analyses, and treatment using Marquis, though other EPM treatment medications are available. The scientists found that 83 percent of horses were neurona-positive on serology and that there was a 12 percent chance EPM would be the diagnosis for any individual horse.
They found that using CSF centesis increased the cost by $547 in diagnostics in 12 percent of cases and decreased the cost by $1,030 to 2,060 (the cost of one or two months of treatment) in 88 percent of cases. Because more horses will be negative for EPM based on these diagnostics, the cost to the client will decrease in 88 percent of cases because the horses won't be treated unnecessarily for EPM, Colmer said.
The study team notes that these findings are regionally specific as other areas of the country have different EPM prevalence.
Read more at The Horse
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