Changes

===Ancillary medication===

===Ancillary medication===

'''NSAIDs''': DMSO IV as 10% solution, thought to reduce CSF pressure and improve clinical status.  Recommended for severe cases of EPM or to avoid worsening inflammation that may be induced by parasite kill(Furr).  Caution: DMSO may cause intravascular haemolysis(Pasq).

'''NSAIDs''': DMSO IV as 10% solution, thought to reduce CSF pressure and improve clinical status.  Recommended for severe cases of EPM or to avoid worsening inflammation that may be induced by parasite kill(Furr).  Caution: DMSO may cause intravascular haemolysis(Pasq).

'''Corticosteroids''': a short course of dexamethasone may be beneficial whilst waiting for antiprotozoals to take effect.  However, use is controversial because cell-mediated immunity is required to control parasites(Pasq) and stress is a proposed risk factor for EPM.(Furr)

'''Corticosteroids''': a short course of dexamethasone may be beneficial whilst waiting for antiprotozoals to take effect.  However, use is controversial because cell-mediated immunity is required to control parasites(Pasq) and stress is a proposed risk factor for EPM.(Furr)

'''Immunomodulators''':

'''Immunomodulators''':

*Levamisole influences T-cell mediated immunity and enhances phagocytosis

*Levamisole influences T-cell mediated immunity and enhances phagocytosis

*Parapox ovis virus (PPOV) immunomodulator (Zylexis, Pfizer Animal Health, Kalamazoo, Mich).  This vaccine has been shown to upregulate the secretion of cytokines including IFN-γ in several species (110 in Furr).  IFN-γ is thought to be essential for the clearance of S neurona, thus PPOV may be useful in EPM.(Furr)

*Parapox ovis virus (PPOV) immunomodulator (Zylexis, Pfizer Animal Health, Kalamazoo, Mich).  This vaccine has been shown to upregulate the secretion of cytokines including IFN-γ in several species (110 in Furr).  IFN-γ is thought to be essential for the clearance of S neurona, thus PPOV may be useful in EPM.(Furr)

'''Multiple vitamin B supplement'''.(Pasq)

'''Multiple vitamin B supplement'''.(Pasq)

===Supportive management===

===Supportive management===

Box rest with deep bedding and good footing or turn out in a flat, grassy field.  Ensure all obstacles are removed and avoid turning out ataxic animals with dominant herd mates.  Recumbent horses will require dedicated support and a sling if available. (Furr)

Box rest with deep bedding and good footing or turn out in a flat, grassy field.  Ensure all obstacles are removed and avoid turning out ataxic animals with dominant herd mates.  Recumbent horses will require dedicated support and a sling if available. (Furr)