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Evidence-Based Review of Diagnosis and Treatment of Sarcocystis neurona Infection (Equine Protozoal Myeloencephalitis)
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1. Introduction
Sarcocystis neurona infection is the most common cause of EPM (equine protozoal myeloencephalitis). This neurologic disease presents a diagnostic challenge to practitioners, because many horses are exposed to the protozoa and clinical signs can mimic many other conditions. Treatment is also challenging, because several medications are available and response to treatment is not consistent among horses. This review summarizes current commercially available diagnostic and therapeutic options and the evidence supporting each option.
2. Diagnosis
A complete neurologic exam should always be the mainstay of diagnosis. If clinical signs cannot be attributed to lesions in one or more regions of the central nervous system (CNS), EPM should not be considered. However, EPM can mimic almost any neurologic disease and cause signs ranging from a single cranial or peripheral neuropathy to diffuse CNS dysfunction. Certain patterns, such as multifocal signs, mixed lower motor neuron and upper motor neuron signs (e.g., both muscle atrophy and spinal proprioceptive ataxia), and asymmetric signs are more commonly observed with EPM than other neurologic diseases. [...]
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