Bilateral ceratohyoidectomy for the resolution of clinical signs associated with temporohyoid osteoarthropathy

Temporohyoid osteoarthropathy (THO) is a progressive bilateral disease of unknown aetiology that most commonly affects adult horses. Irrespective of aetiology, THO frequently results in pain or fracture of the petrous temporal bone during normal movement of the tongue and larynx. In an effort to decrease pain and reduce the likelihood of petrous temporal bone fracture, partial stylohyoidectomy and ceratohyoidectomy have been developed. Serious complications have been reported following stylohyoidectomy and therefore the current recommendation is to perform unilateral ceratohyoidectomy. Benefits of ceratohyoidectomy include a lower risk of vascular and nerve damage and a reduced risk of clinical signs recurrence when compared with stylohyoidectomy. This report describes a case of THO in which clinical signs recurred approximately 2 years after unilateral ceratohyoidectomy was performed. Due to this complication, resection of the contralateral ceratohyoid bone was performed, which resulted in complete resolution of clinical signs. Although the clinical signs are frequently unilateral, the disease is most commonly a progressive bilateral condition and some horses may not have complete resolution of clinical signs when unilateral ceratohyoidectomy is performed. Therefore, if clinical signs persist after unilateral ceratohyoidectomy, a therapeutic consideration should include bilateral ceratohyoidectomy. This report suggests a favourable short‐term prognosis for a horse treated with bilateral ceratohyoidectomy.     

Retrospective study of neurological signs and management of seven English horses with temporohyoid osteoarthropathy

This retrospective study summarises the case details, presenting signs, management and outcome in cases of temporohyoid osteoarthropathy (THO) and describes the findings of diagnostic imaging modalities. The condition appears to be relatively rare in Europe and the objective of this study is to make clinicians aware that THO can have a range of various neurological and clinical presentations. The records of 2 referral equine practices in England were reviewed and 7 horses with THO diagnosed on guttural pouch endoscopy indentified. The clinical and neurological signs, diagnostic procedures, treatment and outcomes were reviewed. Although small, this group is the largest case series of THO from Europe. One horse was a yearling, whereas THO is generally considered usually to affect middle aged and older horses. Computed tomography was used to confirm the diagnosis and demonstrated stylohyoid bone fractures in 2 cases while there was mild increased radionuclide uptake in one of 2 cases undergoing nuclear scintigraphy. Treatment is still controversial, although ceratohyoidectomy led to complete resolution of signs in 2 of 5 cases thus treated and improvement in the other 3. One horse with mild signs treated with antimicrobials and nonsteroidal anti‐inflammatory drugs made a full recovery while another, presented with head shaking and managed with a phased exercise programme, improved but did not resolve completely.     

Brainstem auditory-evoked responses in horses with temporohyoid osteoarthropathy

Background: Facial and vestibulocochlear nerve dysfunction occurs commonly in horses with temporohyoid osteoarthropathy (THO); however, auditory dysfunction has not been thoroughly assessed.
Objective: To determine if auditory abnormalities occur in horses with THO.
Animals: Eleven diseased and 8 control horses.
Methods: This is a prospective study in which brainstem auditory-evoked responses (BAER) were recorded in 11 horses diagnosed with THO through neurologic, endoscopic, radiographic, or computed tomographic examinations. BAER findings were compared with those recorded from 8 adult control horses.
Results: All horses with THO were found to have BAER abnormalities that included complete unilateral BAER loss (82%, n = 9/11), partial unilateral BAER loss (18%, n = 2/11) on the most affected side, and contralateral partial BAER loss (46%, n = 5/11). Nine horses had bilateral THO based on diagnostic imaging findings; of these, 5 (56%) horses also had bilateral BAER abnormalities. The complete absence of BAER in affected horses was most consistent with peripheral sensorineural hearing loss. There was a significant association between complete BAER loss and neurologic and diagnostic abnormalities.
Conclusions and Clinical Importance: Auditory abnormalities such as complete or partial BAER loss are common in horses with THO. The BAER test is an objective diagnostic tool that can aid along with other diagnostic modalities in the assessment, management, and follow-up of horses with THO. Furthermore, BAER studies may help to elucidate the pathophysiology of THO in horses.     

Temporohyoid osteoarthropathy in 33 horses (1993-2000)

A retrospective study of the medical records of 33 horses was performed to determine the clinical and diagnostic abnormalities associated with temporohyoid osteoarthropathy. Data collected from medical records included signalment, presenting complaints, history, physical examination findings, laboratory data, results of diagnostic imaging studies, and treatments. Follow-up information was obtained from a review of case records; by telephone conversation with the owner, veterinarian, or trainer; or by both methods. Of 33 horses with temporohyoid osteoarthropathy, 29 presented with facial nerve (cranial nerve VII) deficits and 23 presented with vestibulocochlear nerve (cranial nerve VIII) deficits. Guttural pouch endoscopy was more reliable than radiography for diagnosis. Of horses with unilateral clinical signs, 22.6% actually had bilateral disease. Magnetic resonance imaging and computed tomography identified the lesions in all horses in which these tests were performed. Of 30 horses for which follow-up information was obtained, 20 (67%) were alive. Eight horses were euthanized and 1 died because of problems associated with temporohyoid osteoarthropathy. Nineteen of 20 surviving horses (95%) were considered by the owner or trainer to be suitable for athletic use. Twelve surviving horses (60%) had residual facial nerve deficits; 11 horses (55%) had residual vestibulocochlear nerve deficits. Horses with temporohyoid osteoarthropathy have a fair prognosis for return to some type of athletic function, but there is risk of acute death. The majority of horses would be expected to have some residual cranial nerve dysfunction, and it could take a year or longer for maximal improvement to occur.     

An epidemiological study of myopathies in Warmblood horses

REASON FOR PERFORMING STUDY: There are few detailed reports describing muscular disorders in Warmblood horses. OBJECTIVES: To determine the types of muscular disorders that occur in Warmblood horses, along with presenting clinical signs, associated risk factors and response to diet and exercise recommendations, and to compare these characteristics between horses diagnosed with polysaccharide storage myopathy (PSSM), those diagnosed with a neuromuscular disorder other than PSSM (non-PSSM) and control horses. METHODS: Subject details, muscle biopsy diagnosis and clinical history were compiled for Warmblood horses identified from records of biopsy submissions to the University of Minnesota Neuromuscular Diagnostic Laboratory. A standardised questionnaire was answered by owners at least 6 months after receiving the muscle biopsy report for an affected and a control horse. RESULTS: Polysaccharide storage myopathy (72/132 horses) was the most common myopathy identified followed by recurrent exertional rhabdomyolysis (RER) (7/132), neurogenic or myogenic atrophy (7/132), and nonspecific myopathic changes (14/132). Thirty-two biopsies were normal. Gait abnormality, 'tying-up', Shivers, muscle fasciculations and atrophy were common presenting clinical signs. Forty-five owners completed questionnaires. There were no differences in sex, age, breed, history or management between control, PSSM and non-PSSM horses. Owners that provided the recommended low starch fat supplemented diet and regular daily exercise reported improvement in clinical signs in 68% (19/28) of horses with a biopsy submission and 71% of horses diagnosed with PSSM (15/21). CONCLUSIONS: Muscle biopsy evaluation was a valuable tool to identify a variety of myopathies in Warmblood breeds including PSSM and RER. These myopathies often presented as gait abnormalities or overt exertional rhabdomyolysis and both a low starch fat supplemented diet and regular exercise appeared to be important in their successful management. POTENTIAL RELEVANCE: Warmbloods are affected by a variety of muscle disorders, which, following muscle biopsy diagnosis can be improved through changes in diet and exercise regimes.     

Retinal detachment in horses: 40 cases (1998-2005)

OBJECTIVE: To determine clinical features, ophthalmic examination findings, etiology, treatment, and outcome of horses diagnosed with retinal detachment (RD). ANIMALS STUDIED: Forty horses, presented to the North Carolina State University and The Ohio State University Veterinary Teaching Hospitals from 1998 to 2005 that were diagnosed with RD. PROCEDURE(S): Horses with documented RD, confirmed either on ophthalmic examination or by ultrasonography, and with a complete medical record were included. Information retrieved from the medical records included signalment, presenting complaint, duration of clinical signs, ophthalmologic examination findings, diagnostics performed, identified cause of the retinal detachment, treatment given, and outcome. RESULTS: Forty horses (46 eyes) were diagnosed with RD. Mean +/- SD duration of clinical signs of ocular disease was 10.5 +/- 14.7 months. Thirty-four horses presented with unilateral involvement, 6 with bilateral, 14 with partial and 32 with complete RD. Ultrasonography was used to make the diagnosis in 26 eyes, while RD was diagnosed on routine ocular examination in 20 eyes. Bullous RD was the only type of RD observed, although small vitreal traction bands were considered secondary to the underlying inflammation or trauma. RD caused by equine recurrent uveitis (ERU) was diagnosed in 27 of 40 (67.5%) horses. Trauma-induced RD involved 10 of the 40 horses (25%). Presenting problems included known ERU (n = 16), acute or progressive vision loss (n = 9), known ocular trauma (n = 6), cataract (n = 6), and a cloudy cornea (n = 3). No horses regained vision after RD despite therapy. Many eyes were enucleated or eviscerated, or the horses were euthanized. Seven eyes with complete RD were noted to be unchanged and comfortable with medical therapy. CONCLUSIONS: The visual prognosis of RD in horses is grave; however, horses with nontraumatic RD (most commonly ERU) may be able to maintain a comfortable but blind globe with anti-inflammatory medical therapy.     

Shear mouth secondary to temporohyoid osteoarthropathy

Temporohyoid osteoarthropathy (THO) is a progressive disease of unknown aetiology that can result in pain during normal movement of the tongue and larynx during mastication and deglutition. Shear mouth is a rare, poorly described condition, which may be associated with painful dental disease. This report describes a case of shear mouth attributable to THO. The THO was surgically treated by undertaking a left-sided ceratohyoidectomy (CHO) and the shear mouth resolved over the course of 18 months.     

Caudal compression of the infraorbital nerve: A novel surgical technique for treatment of idiopathic headshaking and assessment of its efficacy in 24 horses

Reasons for designing and reporting technique: Idiopathic headshaking has remarkable similarities to human neuropathic facial pain syndromes associated with post herpetic and trigeminal neuralgia. These derive from abnormal sensory function within the peripheral or central pathways of the trigeminal nerve (TgN). Limiting input from the TgN can be helpful in controlling the perception of pain. Rhizotomy of the infraorbital branch of the TgN as it emerges from the infraorbital canal has been reported but has a poor efficacy. A novel technique involves compression of the nerve at a more caudal location within the infraorbital canal and the technique requires validation. Hypothesis: Caudal compression of the infraorbital nerve with platinum coils, performed in horses diagnosed with idiopathic headshaking, results in a decrease in clinical signs. Methods: Caudal compression of the infraorbital nerve, using platinum embolisation coils, was performed under fluoroscopic guidance. Clinical records of 24 idiopathic headshakers that had undergone this procedure were reviewed. Follow‐up information was obtained by telephone questionnaire with the owner or referring veterinary surgeon. Results: All 24 horses had at least one surgical procedure. Median follow‐up time was 6 months. There were 2 horses which had surgery 2 weeks before follow‐up and these were excluded from the analysis of outcome. Following one surgery, 13/22 horses (59.0%) had a successful outcome. Of the 9 horses that did not improve, surgery was repeated in 6 cases. Two of these horses had a successful outcome. Overall, a successful outcome was obtained in 16/19 horses (84.2%). Conclusions: This surgical technique is likely to prevent input from the TgN at a more caudal location then the previously described infraorbital neurectomy. The technique requires refinement.     

Intestinal neoplasia in horses

BACKGROUND: Intestinal neoplasia of horses is inadequately described. HYPOTHESIS: Intestinal neoplasia of horses has characteristic clinicopathologic features. ANIMALS: Thirty-four horses with intestinal neoplasia. METHODS: Retrospective study. RESULTS: Anamnesis, clinical signs, clinicopathologic and pathologic findings in 34 adult horses diagnosed histologically with intestinal neoplasia were reviewed. The horses ranged in age from 2 to 30 years (mean 16.6 years at presentation). The Arabian breed was most represented and there was no sex predisposition. The most common presenting complaints were weight loss, colic, anorexia, and fever. The most consistent clinical signs were poor body condition, tachycardia, tachypnea, fever, and diarrhea. Useful diagnostic tools included rectal examination, routine blood analyses, abdominocentesis, ultrasonographic examination, rectal biopsy, and exploratory laparotomy. Alimentary lymphoma was the most common intestinal neoplasia identified, followed by adenocarcinoma and smooth muscle tumors. The small intestine was the most common segment of intestine affected for all neoplasms. Intestinal neoplasia was diagnosed antemortem in 13 of 34 (38%) horses. The median time from onset of clinical signs to death or euthanasia was 1.9 months. The discharge rate was 15%. Although the longest survival was observed in horses with jejunal adenocarcinoma, all horses were eventually euthanized because of intestinal neoplasia. CONCLUSIONS: Arabian horses were 4.5 times more likely to have intestinal neoplasia diagnosed than were other breeds.     

Gastric Neoplasia in Horses

Background: Gastric neoplasia of horses is incompletely described.
Objective: Provide history, clinical signs, and clinicopathological and pathological findings associated with gastric neoplasia in horses.
Animals: Twenty-four horses with gastric neoplasia.
Methods: Retrospective study. History, clinical signs, and clinicopathological and pathologic findings in horses diagnosed histologically with gastric neoplasia were reviewed.
Results: Horses ranged in age from 9 to 25 years (median 18 years at presentation). There was no apparent breed or sex predisposition. The most common presenting complaints were inappetance (17/24), weight loss (14/24), lethargy (7/24), hypersalivation (7/24), colic (5/24), and fever (5/24). The most consistent clinical signs were tachypnea (10/19), decreased borborygmi (8/19), and low body weight (7/17). Useful diagnostic tests included rectal examination, routine blood analysis, gastroscopy, abdominocentesis, and transabdominal ultrasound examination. Anemia was the most common hematologic abnormality encountered (7/19), and hypercalcemia of malignancy was seen in 4/16 horses. Squamous cell carcinoma was the most common tumor identified (19/24), and was most often (14/19) found as a single ulcerated, necrotic mass in the nonglandular portion of the stomach. Other gastric neoplasms encountered were leiomyoma (n=2), mesothelioma (n=1), adenocarcinoma (n=1), and lymphoma (n=1). Metastatic neoplasia was found in 18/23 horses. The median time from onset of clinical signs to death was 4 weeks, and all horses died or were euthanized because of gastric neoplasia.
Conclusions: Squamous cell carcinoma is the most common primary gastric neoplasia in horses. The survival time after diagnosis of gastric neoplasia in horses is short.     

Vestibular syndrome associated with temporohyoid joint fusion and temporal bone fracture in three horses

Acute onset of vestibulocochlear and facial nerve dysfunction due to a stress fracture of the petrous part of the temporal bone was diagnosed in 3 horses. The fracture was secondary to chronic inflammatory changes in the petrous part of the temporal bone and the proximal stylohyoid bone, with fusion of the temporohyoid joint. Bacterial meningoencephalitis was a complicating factor. Treatment resulted in reduction of severity of clinical signs in 2 of the 3 cases, but residual compensated vestibular deficits persisted.     

Sabulous cystitis in the horse: 13 cases (2013–2020)

The objective of this study was to describe the clinical findings, medical management, and outcomes of horses with sabulous cystitis, and to describe a high flow bladder lavage procedure in horses that are standing or under general anesthesia. The medical records of 13 horses diagnosed with sabulous cystitis via cystoscopy between 2013 and 2020 were reviewed. Geldings (92%) and Warmbloods (46%) were overrepresented. The most common presenting complaint was urinary incontinence (69%). Complete blood cell count, serum biochemistry profile and urine cytology results were non-specific. Six (46%) horses had various degrees of erosion, ulceration, and hemorrhage of the bladder mucosa. All horses were treated with bladder lavage either with standing sedation (n = 12) or general anesthesia (n = 2), as well as antimicrobials (54%), anti-inflammatory drugs (62%), bethanechol (15%), and phenazopyridine (15%). Most horses (85%) were discharged from the hospital, but only a small percentage (23%) was reported as having no urinary abnormalities on follow-up communication.Key clinical message:Copious bladder lavage with a high flow rate system could mitigate the acute clinical signs and improve the quality of life of horses with sabulous cystitis, but the prognosis for return to previous level of athletic performance and long-term survival is guarded.     

Epidemiological features and association with crib‐biting in horses with neurological disease associated with temporohyoid osteoarthropathy (1991–2008)

A retrospective study of 43 cases of temporohyoid osteoarthropathy was performed to evaluate the epidemiological features and a possible association with crib‐biting. Data collected from records included case details, what diagnostics were utilised, whether medical or surgical treatment was administered, and outcome. Owners were contacted via telephone and asked whether the horse had displayed crib‐biting behaviour. Forty‐three horses were diagnosed with neurological disease associated with temporohyoid osteoarthropathy, 62.8% of which were Quarter Horse‐types. Median age at presentation was 10 years and median duration of neurological signs prior to presentation was 3 days. Skull radiographs and guttural pouch endoscopy were used to definitively diagnose temporohyoid osteoarthropathy in 72% of the cases. Of 43 horses, 21 received medical treatment and 15 surgical treatment, with an overall survival rate of 55.8%. Crib‐biting was observed in 31.3% of cases and there was a significant association between being afflicted with THO and likelihood of possessing the behaviour. Horses with neurological disease associated with THO were 8 times more likely to be crib‐biters compared to the general population.     

Tearing of the medial palmar intercarpal ligament in the equine midcarpal joint.

Tearing of the medial palmar intercarpal ligament is described in 45 intercarpal (midcarpal) joints in 42 horses (37 racehorses, 5 non-racehorses). Of the 37 racehorses, there were 20 Quarter Horses, 14 Thoroughbreds and 3 Standardbreds. The patients had been referred for arthroscopic surgery for removal of osteochondral chip fragments that had been diagnosed radiographically or diagnostic arthroscopy of a persistent carpal problem. The problem was unilateral in 39 horses and bilateral in 3. The presenting clinical signs were lameness and/or persistent synovial effusion. In one instance, the presenting complaint was haemarthrosis. Osteochondral chip fragments were present in the joint affected with tearing in 23 horses. In 6 horses in which osteochondral fragments were present in other joints, the degree of synovial effusion was greatest in the midcarpal joint with ligamentous tearing. In most of the 22 midcarpal joints where carpal chip fragmentation and ligamentous tearing were present concomitantly, the degree of clinical compromise was greater than normally seen with that degree of osteochondral fragmentation. A ligament was designated as torn when a defect was present in the ligament. This usually took the form of frayed fibres suspended in the irrigating solution, presenting a transverse type of defect in the dorsal aspect of the lateral portion of ligament. However, longitudinal tearing was present in 1 case and tearing was noted in the palmar aspect of the ligament in 2 other cases. The shredded fibres were trimmed in most cases and this allowed better definition of the amount of ligament considered to be torn. The degree of damage ranged from 10% to 100% of the width considered to be torn.(ABSTRACT TRUNCATED AT 250 WORDS)     

A survey of neurological diseases in horses

SUMMARY: Case records of 450 horses with signs of neurological disease are reviewed. One hundred and nineteen horses with neurological disease due to trauma were examined, of which 60 were due to spinal cord trauma, 47 to brain or cranial nerve trauma and 12 to peripheral nerve trauma. Cervical vertebral fractures/trauma were the most common injury. Basisphenold/basloccipital bone fractures were the most common form of cranial trauma and facial nerve paralysis the most common cranial nerve injury. Eighty-nine horses with neurological disease due to malformation were examined. Cervical vertebral malformation occurred in 83 horses and congenital defects in 6 foals. Neurological disease due to inflammation or infection occurred in 30 horses. The most common disease of this type was meningitis, which occurred in 11 horses and foals. Neoplasms in the CNS caused neurological disease in 8 horses. The final category was miscellaneous neurological disease, which was diagnosed in 204 horses. Diseases in this category included neonatal (28 cases), toxic/metabolic (27 cases), idiopathic (133 cases), degenerative (3 cases) and other neurological diseases (13 cases). The most common condition was idiopathic laryngeal hemiplegia (116 cases).
Where possible, diagnosis relied on a thorough neurological examination with use of ancillary tests in selected cases including rhinolaryngoscopy, radiography, myelography, ophthalmoscopy and cerebrospinal fluid analysis when indicated. In many cases necropsy and histopathological confirmation or diagnosis was necessary.     

Subepiglottic cysts in 15 horses

Subepiglottic cysts (SECs) are an infrequent cause of upper respiratory tract noise and exercise intolerance in horses. They may also be associated with no clinical signs and be an incidental finding during routine upper airway endoscopy. The aim of this study was to assess the effect on performance of horses undergoing surgical removal of SECs. The case records of 15 horses (1995–2009) diagnosed with SECs were retrieved. Eleven (73%) of the 15 horses included in the study were Thoroughbred racehorses. Eleven (73%) of the 15 horses had no preoperative clinical signs related to the SECs, with the remaining 4 (27%) having a respiratory noise (n = 4), nasal discharge (n = 1), difficulty swallowing (n = 1) or a cough (n = 1). Endoscopic examination in the standing horse was diagnostic in 93% (n = 14) of horses. Nine (82%) of the 11 Thoroughbred horses were yearlings, of which only one horse (11%) presented with clinical signs consisting of a respiratory noise and nasal discharge. Four of the 11 (36%) Thoroughbred horses were found to have concurrent epiglottic entrapment. Surgical removal was successful in all cases. Eight of the 11 (73%) Thoroughbred horses in this study raced following SEC removal. The majority of SECs are identified during routine endoscopic examinations and are not associated with clinical signs. The prognosis following surgical removal of SECs is good and future performance does not appear to be affected.     

Non-strangulating intestinal infarction in horses in the UK: A review of 15 cases

The clinicopathological features of 15 horses diagnosed with non-strangulating intestinal infarction (NSII) based on identification of focal areas of intestinal necrosis without mesenteric strangulation were reviewed. The mean age at presentation was 16.3 years, median 13 years, and there was no age, sex, or breed predilection. The major presenting clinical signs included: acute colic ≤ 24 h duration in nine horses; diarrhoea, depression, and inappetence in four horses; and low-grade chronic or recurrent colic, depression, and inappetence in two horses. One horse presented with both acute colic and diarrhoea. Predisposing diseases included colitis or typhlocolitis in five horses and an initial strangulating small intestinal obstruction in three horses, but in seven horses no underlying or predisposing disease was identified. Four cases were managed medically and 11/15 were managed surgically. The most useful diagnostic test was exploratory celiotomy and the only successful treatment was complete resection of the necrotic intestine. Prognosis for survival was poor with a survival rate of only 1/15 (7%). Among the 15 horses, both single and multiple NSII lesions were seen, and they occurred in both the small intestine and large intestines. There was no evidence of Strongylus vulgaris infestation in any of the affected horses.     

West Nile virus encephalomyelitis in horses: 46 cases (2001)

OBJECTIVE: To determine signalment, clinical findings, results of diagnostic testing, outcome, and postmortem findings in horses with West Nile virus (WNV) encephalomyelitis. DESIGN: Retrospective study. ANIMALS: 46 horses with WNV encephalomyelitis. PROCEDURE: Clinical data were extracted from medical records of affected horses. RESULTS: On the basis of clinical signs and results of serologic testing, WNV encephalomyelitis was diagnosed in 46 of 56 horses with CNS signs. Significantly more males than females were affected. Increased rectal temperature, weakness or ataxia, and muscle fasciculations were the most common clinical signs. Paresis was more common than ataxia, although both could be asymmetrical and multifocal. Supportive treatment included anti-inflammatory medications, fluids, antimicrobials, and slinging of recumbent horses. Results of the IgM capture ELISA and the plaque reduction neutralization test provided a diagnosis in 43 horses, and only results of the plaque reduction neutralization test were positive in 3 horses. Mortality rate was 30%, and 71% of recumbent horses were euthanatized. One horse that had received 2 vaccinations for WNV developed the disease and was euthanatized. Follow-up communications with 19 owners revealed that most horses had residual deficits at 1 month after release from the hospital; abnormalities were resolved in all but 2 horses by 12 months after release. CONCLUSIONS AND CLINICAL RELEVANCE: Our findings were similar to those of previous WNV outbreaks in horses but provided additional clinical details from monitored hospitalized horses. Diagnostic testing is essential to diagnosis, treatment is supportive, and recovery rate of discharged ambulatory horses is < 100%.     

Evidence that antibodies against recombinant SnSAG1 of Sarcocystis neurona merozoites are involved in infection and immunity in equine protozoal myeloencephalitis

Sarcocystis neurona is the principal etiologic agent of equine protozoal myeloencephalitis (EPM). An immunodominant protein of S. neurona, SnSAG-1, is expressed by the majority of S. neurona merozoites isolated from spinal tissues of horses diagnosed with EPM and may be a candidate for diagnostic tests and prophylaxis for EPM. Five horses were vaccinated with adjuvanted recombinant SnSAG1 (rSnSAG1) and 5 control (sham vaccinated) horses were vaccinated with adjuvant only. Serum was evaluated pre- and post-vaccination, prior to challenge, for antibodies against rSnSAG1 and inhibitory effects on the infectivity of S. neurona by an in vitro serum neutralization assay. The effect of vaccination with rSnSAG1 on in vivo infection by S. neurona was evaluated by challenging all the horses with S. neurona merozoites. Blinded daily examinations and 4 blinded neurological examinations were used to evaluate the presence of clinical signs of EPM. The 5 vaccinated horses developed serum and cerebrospinal fluid (CSF) titers of SnSAG1, detected by enzyme-linked immunosorbent assay (ELISA), post-vaccination. Post-vaccination serum from vaccinated horses was found to have an inhibitory effect on merozoites, demonstrated by in vitro bioassay. Following the challenge, the 5 control horses displayed clinical signs of EPM, including ataxia. While 4 of the 5 vaccinated horses did not become ataxic. One rSnSAG-1 vaccinated horse showed paresis in 1 limb with muscle atrophy. All horses showed mild, transient, cranial nerve deficits; however, disease did not progress to ataxia in rSnSAG-1 vaccinated horses. The study showed that vaccination with rSnSAG-1 produced antibodies in horses that neutralized merozoites when tested by in vitro culture and significantly reduced clinical signs demonstrated by in vivo challenge.