inflammatory encephalitis

EPM drugs comparing efficacy, treatment duration and safety
100
90
80
70
Resolved-- 60
Tx duration50
40
30
20
10
0
Oroquin-10
Marquis
Efficacy
Protazil
ReBalance
Treatment duration
Decoquinate/levamisole in 150 horses with no adverse events.
Legend is an 11 YO gelding that went
from severe ataxia to good with 10 days
treatment with Oroquin-10.
This horse had complicating
inflammatory encephalitis
100.0%
90.0%
The “60%” Group
80.0%
Chronic disease
Unresponsive to Triazine or
pyrimethamine/sulfa
70.0%
60.0%
94.2%
Levamisole therapy
alleviates signs in this
group
50.0%
40.0%
30.0%
20.0%
5.8%
12.7
10.0%
0.0%
Success
No change
60% grp
Six percent, with mild signs, opted for low dose treatment. There were 7.7%
of horses that responded to anti-inflammatory drugs (DMSO, steroids, or
levamisole) after day 10 indicating that inflammatory encephalitis is a
component of disease.
80.0%
70.0%
75.0%
60.0%
50.0%
40.0%
30.0%
20.0%
10.0%
0.0%
7.7%
6.0%
Prevent therapy
Prevent follow Tx
Low Dose Options
A-inflam
Levamisole has a place in the treatment of EPM if
parasites are effectively killed
Ongoing trials: 012092 & 012219
Enrollment criteria 012092:
Veterinarian trained on the protocol—complete EPM 2012 course
Horse has antibody 1, 5, or 6 and clinical signs of EPM
Enrollment criteria 012219
Veterinarian trained on the protocol—complete EPM 2012 course
Horse has inflammatory encephalitis– “relapse” with conventional treatment
Identify horses that have or are at risk for EPM
Identify presence of antibody in serum
Identify phenotype of S. neurona causing EPM
Peptide 1, 5, 6 ELISA –quantative
Point of care identification at 1:20 dilution
10 day therapy
Signs and antibody= institute treatment
Treatment response in horses in 5 days or less
Identify inflammatory encephalitis
Vaccinate
phenotype specific
prevents allergic encephalitis
Prevention by low dose therapy goal is by stimulating protective immunity
phenotype independent
EPM suspect
ELISA Titer
Orogin
94%
OK within 10 days
ELISA titer 4-6 weeks
Not 100% OK
6%
60% improve with plateau
No clinical or Ab change
Re-exposure possible? Prevention
Continue diagnostics
Antibody still elevated
Low dose prevention
13%
3%
Antibody decreases, slow imp.
no progress, plateau, worse
Levamisole, Quest
DMSO IV, Steroids,
Levamisole
Inflammatory Encephalitis ,
vaccinate
We are working on the diagnosis and mechanism of
inflammatory encephalitis in EPM
Inflammatory encephalitis—diagnostics and
mechanism of disease
CRP
Encysted parasites—and the effects on
inflammation