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Topic:Equine Health

Equine health encompasses the study and management of diseases, disorders, and overall well-being of horses. It involves understanding various physiological systems, preventive care, and treatment strategies to maintain optimal health in equine populations. Common areas of focus include nutrition, infectious diseases, orthopedic conditions, and reproductive health. Research in equine health aims to advance knowledge on diagnostic methods, therapeutic interventions, and management practices that improve horse welfare and performance. This page collects peer-reviewed research studies and scholarly articles that explore the diverse aspects of equine health, offering insights into current findings and advancements in the field.
Non-Targeted Detection of Synthetic Oligonucleotides in Equine Serum Using Liquid Chromatography-High-Resolution Mass Spectrometry.
International journal of molecular sciences    May 25, 2024   Volume 25, Issue 11 5752 doi: 10.3390/ijms25115752
Helmes E, Montgomery J, Alarcio G, Mendoza HG, Blea JA, Beal PA, Moeller BC.There is great concern in equine sport over the potential use of pharmaceutical agents capable of editing the genome or modifying the expression of gene products. Synthetic oligonucleotides are short, single-stranded polynucleotides that represent a class of agents capable of modifying gene expression products with a high potential for abuse in horseracing. As these substances are not covered by most routine anti-doping analytical approaches, they represent an entire class of compounds that are not readily detectable. The nucleotide sequence for each oligonucleotide is highly specific, which m...
What is your diagnosis? Cerebrospinal fluid from a horse.
Veterinary clinical pathology    May 24, 2024   Volume 53 Suppl 2 152-154 doi: 10.1111/vcp.13216
Larosche SA, Weyna AAW, Stanton JB, Hart K, Meichner K.No abstract available
Molecular cytogenetic screening of sex chromosome abnormalities in young horse populations.
Equine veterinary journal    May 24, 2024   doi: 10.1111/evj.14097
Bugno-Poniewierska M, Jankowska M, Raudsepp T, Kowalska K, Pawlina-Tyszko K, Szmatola T.Chromosomal abnormalities occur in the equine population at a rate of approximately 2%. The use of molecular cytogenetic techniques allows a more accurate identification of chromosomal abnormalities, especially those with a low rate of abnormal metaphases, demonstrating that the actual incidence in equine populations is higher. Objective: Estimation of the number of carriers of karyotypic abnormalities in a sample from a population of young horses of various breeds, using molecular cytogenetic techniques. Methods: Cross-sectional. Methods: Venous blood samples were collected from 500 young hor...
Risk assessment in equine anesthesia: a first evaluation of the usability, utility and predictivity of the two-part CHARIOT.
Frontiers in veterinary science    May 23, 2024   Volume 11 1384525 doi: 10.3389/fvets.2024.1384525
Brumund L, Wittenberg-Voges L, Rohn K, Kästner SBR.An accurate risk score that can predict peri-anesthetic morbidity and mortality in equine patients could improve peri-operative management, outcome and client communication. Unassigned: Three hunded horses underwent pre-anesthetic risk assessment using the American Society of Anesthesiologists-Physical Status augmented with equine-specific diseases (ASA-PS-Equine), a multifactorial 10-part rubric risk scale (10-RS), and a combination of both, the Combined horse anesthetic risk identification and optimization tool (CHARIOT). Intra-and post-anesthetic complications, the recovery phase and mortal...
Approach to Inflammatory Bowel Disease.
The Veterinary clinics of North America. Equine practice    May 23, 2024   Volume 40, Issue 2 287-306 doi: 10.1016/j.cveq.2024.04.004
Timko K.Inflammatory bowel disease (IBD) in the horse encompasses a group of infiltrative gastrointestinal disorders resulting in malabsorption, maldigestion, weight loss, colic, and sometimes diarrhea. The type of IBD can be classified as granulomatous, lymphocytic-plasmacytic, or eosinophilic enterocolitis. The diagnosis of IBD in equids is based on consistent clinical signs and clinicopathologic findings in conjunction with confirmatory histopathology from a gastrointestinal biopsy. Treatment usually consists of a combination of immunosuppressive medications, anthelmintics, and dietary modification...
The Application of Infrared Thermography in the Assessment of BEMER Physical Vascular Therapy on Body Surface Temperature in Racing Thoroughbreds: A Preliminary Study.
Animals : an open access journal from MDPI    May 23, 2024   Volume 14, Issue 11 1538 doi: 10.3390/ani14111538
Nawrot K, Soroko-Dubrovina M, Zielińska P, Dudek K, Howell K.The study aimed to evaluate the impact of BEMER (Physical Vascular Therapy) on body surface temperature using infrared thermography (IRT) in the distal parts of the forelimbs in Thoroughbreds. The study tested the hypothesis that BEMER therapy leads to an increase in body surface temperature and blood vessel diameter in the distal parts of the forelimbs. The study involved 16 horses, split into 2 groups: active BEMER ( = 8) and sham ( = 8). The active BEMER group had BEMER boots applied to the distal parts of the forelimbs, whereas the sham group had BEMER boots applied without activation of t...
The application of a single session of capacitive resistive electric transfer 24 h before exercise modifies the accelerometric pattern in standardbred racing trotters.
BMC veterinary research    May 22, 2024   Volume 20, Issue 1 217 doi: 10.1186/s12917-024-04039-2
Argüelles D, Saitua A, Miraz R, Calle-González N, Requena F, Nocera I, Vitale V, Sgorbini M, Muñoz A.It has been reported that capacitive resistive electric transfer (CRET) increases blood circulation, hemoglobin oxygenation and temperature in muscles. The attributed benefits of these changes have been linked to improved athletic performance, enhanced muscle flexibility and fastening recovery from exercise-induced fatigue. For all of this, the present research aims to investigate whether the application of CRET 24 h before exercise affects the accelerometric pattern in horses during exercise. Six sound Standardbred trotters were subjected to a CRET session of 40 min of duration, applied on ...
The balance of n-6 and n-3 fatty acids in canine, feline, and equine nutrition: exploring sources and the significance of alpha-linolenic acid.
Journal of animal science    May 22, 2024   Volume 102 doi: 10.1093/jas/skae143
Burron S, Richards T, Krebs G, Trevizan L, Rankovic A, Hartwig S, Pearson W, Ma DWL, Shoveller AK.Both n-6 and n-3 fatty acids (FA) have numerous significant physiological roles for mammals. The interplay between these families of FA is of interest in companion animal nutrition due to the influence of the n-6:n-3 FA ratio on the modulation of the inflammatory response in disease management and treatment. As both human and animal diets have shifted to greater consumption of vegetable oils rich in n-6 FA, the supplementation of n-3 FA to canine, feline, and equine diets has been advocated for. Although fish oils are commonly added to supply the long-chain n-3 FA eicosapentaenoic acid (EPA), ...
Strongylids of Domestic Horses in Eastern Slovakia: Species Diversity and Evaluation of Particular Factors Affecting Strongylid Communities.
Acta parasitologica    May 22, 2024   Volume 69, Issue 2 1284-1294 doi: 10.1007/s11686-024-00854-7
Kuzmina TA, Königová A, Burcáková L, Babjak M, Syrota Y.This study aimed to examine the species diversity and structure of the strongylid community in domestic horses in Eastern Slovakia. Also, an analysis of the impact of age, sex, and collection location factors on the strongyid communities was performed. Methods: Twenty-seven horses 1.5-21 years old from two farms in eastern Slovakia with different horse-management conditions were studied. Strongylids were collected after horse treatments with Noromectin (0.2 mg ivermectin); 66,170 specimens were collected and identified. Faecal egg count reduction test (FECRT) was performed following fenbendaz...
Case report: Equine metacarpophalangeal joint partial and full thickness defects treated with allogenic equine synovial membrane mesenchymal stem/stromal cell combined with umbilical cord mesenchymal stem/stromal cell conditioned medium.
Frontiers in veterinary science    May 22, 2024   Volume 11 1403174 doi: 10.3389/fvets.2024.1403174
Reis IL, Lopes B, Sousa P, Sousa AC, Rêma A, Caseiro AR, Briote I, Rocha AM, Pereira JP, Mendonça CM, Santos JM, Lamas L, Atayde LM, Alvites RD....Here, we describe a case of a 5-year-old show-jumping stallion presented with severe lameness, swelling, and pain on palpation of the left metacarpophalangeal joint (MCj). Diagnostic imaging revealed full and partial-thickness articular defects over the lateral condyle of the third metacarpus (MC3) and the dorsolateral aspect of the first phalanx (P1). After the lesion's arthroscopic curettage, the patient was subjected to an innovative regenerative treatment consisting of two intra-articular injections of equine synovial membrane mesenchymal stem/stromal cells (eSM-MSCs) combined with umbilic...
Eosinophils Play a Surprising Leading Role in Recurrent Urticaria in Horses.
Vaccines    May 21, 2024   Volume 12, Issue 6 doi: 10.3390/vaccines12060562
Birkmann K, Jebbawi F, Waldern N, Hug S, Inversini V, Keller G, Holm A, Grest P, Canonica F, Schmid-Grendelmeier P, Fettelschoss-Gabriel A.Urticaria, independent of or associated with allergies, is commonly seen in horses and often shows a high reoccurrence rate. Managing these horses is discouraging, and efficient treatment options are lacking. Due to an incidental finding in a study on horses affected by insect bite hypersensitivity using the eosinophil-targeting eIL-5-CuMV-TT vaccine, we observed the prevention of reoccurring seasonal urticaria in four subsequent years with re-vaccination. In an exploratory case series of horses affected with non-seasonal urticaria, we aimed to investigate the role of eosinophils in urticaria....
Biomarkers of in vivo platelet activation in thoroughbreds during their first long-term training.
Frontiers in veterinary science    May 20, 2024   Volume 11 1395423 doi: 10.3389/fvets.2024.1395423
Miglio A, Falcinelli E, Mezzasoma AM, Busechian S, Rueca F, Gresele P, Antognoni MT.Physical exercise has an activating effect on platelet function that differs between trained and untrained subjects, depending on the type of exercise and training status. In humans, soluble P-selectin (sP-sel) and platelet-derived extracellular vesicles (PEVs) are considered reliable markers of platelet activation during exercise. In untrained humans, they increase after transient physical exercise, whereas long-term training induces a decrease in their resting levels due to an improved ability to adapt to hemodynamic changes. The aim of this study was to assess whether circulating levels of...
Equine Talocalcaneal subluxation.
Journal of equine veterinary science    May 19, 2024   Volume 138 105101 doi: 10.1016/j.jevs.2024.105101
Bertelsen L.A Quarter horse filly was evaluated for a two-week old wound of the right hind cannon bone after the mare stepped on her. A sequestrum was noted radiographically and was surgically debrided. After continued follow-up a left hind varus deformity was noted and was corrected with a lateral transphyseal screw in the distal left tibia. After the varus deformity was improved, a lateromedial radiograph was taken of the distal left tibia and tarsus and talocalcaneal subluxation was seen. The same view was taken of the right tarsus and the same deformity was noted. After finding no case reports on the ...
The Best Protocol to Treat Equine Skin Wounds by Second Intention Healing: A Scoping Review of the Literature.
Animals : an open access journal from MDPI    May 18, 2024   Volume 14, Issue 10 doi: 10.3390/ani14101500
Ribeiro G, Carvalho L, Borges J, Prazeres J.Equine skin wound treatment continues to be a challenge for veterinarians. Despite being a frequent practice, it remains difficult to choose an evidence-based treatment protocol. This study aimed to comprehensively explore the literature and provide a scoping review of therapeutic strategies for equine skin wounds and identify knowledge gaps and opportunities for future research. This review was conducted using specific criteria to select literature that described methods to manage second intention wound healing. After removing duplicates and screening papers for suitability, 81 manuscripts we...
Salivary analysis to unveil the paradigma of stress of domestic horses reared in the wild.
Scientific reports    May 17, 2024   Volume 14, Issue 1 11266 doi: 10.1038/s41598-024-62172-2
Bazzano M, Marchegiani A, La Gualana F, Petriti B, Spaterna A, Laus F.Horse welfare is the product of multiple factors, including behavioral and physiological adjustments to cope with stressful situation regarding environment and housing condition. Collectively, it is supposed that a horse kept in the wild has a lower level of stress than other housing system, and the aim of the present study was to investigate the level of stress in domestic horses reared in the wild and then moved to human controlled housing, through saliva analysis. Twelve clinically healthy Catria (Italian local breed) mares, usually reared in the wild, were moved into collective paddocks fo...
Ultrasonographic measurement of diaphragm muscle activity for assessment of respiratory function in horses.
Journal of equine veterinary science    May 17, 2024   105100 doi: 10.1016/j.jevs.2024.105100
Oliveira BE, Canola PA.Ultrasonographic imaging of the diaphragm is a non-invasive alternative for respiratory function evaluation in horses. This study aimed to measure diaphragm thickness, thickening (change in thickness with contraction) and thickening fraction in healthy adult horses during tidal breathing and forced vital capacity. Correlation between body weight (≤400 kg and >400 kg) and diaphragm thickness was investigated. To that purpose, 20 adult horses, weight 409±50 kg, height 1.47±0.05 m, and age 16±6 years were included in the study. Diaphragm thickness was measured at end-inspiration and end-e...
Hematological and physiological responses in polo ponies with different field-play positions during low-goal polo matches.
PloS one    May 16, 2024   Volume 19, Issue 5 e0303092 doi: 10.1371/journal.pone.0303092
Sanigavatee K, Poochipakorn C, Huangsaksri O, Wonghanchao T, Yalong M, Poungpuk K, Thanaudom K, Chanda M.Strenuous exercise in traditional polo matches creates enormous stress on horses. Hematological and physiological measures may vary across different field-play positions. This study aimed to investigate the effort intensity and the impact of exertion on hematology and heart rate variability (HRV) in polo ponies with different positions. Thirty-two ponies, divided equally into eight teams, were studied. Each comprises forwards (number 1), midfielders (numbers 2 and 3), and defenders (number 4). Team pairs played the first chukka in four low-goal polo matches. Percent maximum heart rate (%HRmax)...
Case report: Findings in ovaries development from an aborted equine fetus.
Frontiers in veterinary science    May 16, 2024   Volume 11 1275220 doi: 10.3389/fvets.2024.1275220
Cuccato M, Bertuglia A, Divari S, Brambilla E, Grieco V, Bollo E, Scaglione FE.An aborted female foal was submitted for necropsy. During the gross examination, the ovaries were pale, grayish, and enlarged (6 × 5 cm), with a well-developed vascular structure surrounding the external surface; the cut surface of the ovaries showed a brownish parenchyma with white follicular areas mainly localized in the peripheral region. The ovaries were fixed for histological investigations. The histological evaluation of the ovaries showed polygonal-shaped cells with abundant cytoplasm and round or oval nuclei, arranged in cords of single cells. The tissue architecture was characterized...
Potent drug delivery enhancement of betulinic acid and NVX-207 into equine skin in vitro – a comparison between a novel oxygen flow-assisted transdermal application device and microemulsion gels.
BMC veterinary research    May 16, 2024   Volume 20, Issue 1 202 doi: 10.1186/s12917-024-04064-1
Zscherpe P, Kalbitz J, Weber LA, Paschke R, Mäder K, von Rechenberg B, Cavalleri JV, Meißner J, Klein K.Gray horses are predisposed to equine malignant melanoma (EMM) with advancing age. Depending on the tumor's location and size, they can cause severe problems (e.g., defaecation, urination, feeding). A feasible therapy for EMM has not yet been established and surgical excision can be difficult depending on the location of the melanoma. Thus, an effective and safe therapy is needed. Naturally occurring betulinic acid (BA), a pentacyclic triterpene and its synthetic derivate, NVX-207 (3-acetyl-betulinic acid-2-amino-3-hydroxy-2-hydroxymethyl-propanoate) are known for their cytotoxic properties ag...
The effect of uterine massage and number of embryo flushing attempts on embryo recovery in mares.
Theriogenology    May 15, 2024   Volume 224 94-101 doi: 10.1016/j.theriogenology.2024.05.017
Sala-Ayala L, Martínez-Boví R, Querol-Paajanen A, Cuervo-Arango J.The aims of this study were to determine the effect of the embryo flushing technique and the number of flushing attempts performed by operators of different experience on embryo recovery (ER). Ten non-lactating mares were inseminated with the same stallion in six cycles each (n = 60). Embryo flushing (EF) was performed 7-9 days after ovulation by three operators (OP; 20 EF cycles each): OP1 had performed >500 EF before the study, while OP2 and 3 had performed 0 EF. Each EF was performed with 2 flushing attempts (FA) using 1L of ringer's lactate "in-and-out" using two EF techniques: 1) ...
Evaluation of breeding strategies to reduce the inbreeding rate in the Friesian horse population: Looking back and moving forward.
Journal of animal breeding and genetics = Zeitschrift fur Tierzuchtung und Zuchtungsbiologie    May 15, 2024   Volume 141, Issue 6 668-684 doi: 10.1111/jbg.12872
Steensma MJ, Doekes HP, Pook T, Derks MFL, Bakker N, Ducro BJ.In the past, small population sizes and unequal ancestor contributions have resulted in high inbreeding rates (ΔF) in the Friesian horse. Two decades ago, the studbook implemented a mating quota and started publishing individual kinships and reduced ΔF below 1% per generation. However, since then, the breeding population size has decreased and this raises the question whether current breeding strategies are sufficient to keep ΔF below desired rates. The aim of this study was to (1) reflect on past inbreeding trends and their main determinants, using pedigree analysis and (2) evaluate the ef...
Feasibility of hemoperfusion using extracorporeal therapy in the horse.
Frontiers in veterinary science    May 14, 2024   Volume 11 1414426 doi: 10.3389/fvets.2024.1414426
Hobbs KJ, Le Sueur ANV, Burke MJ, Cooper BL, Sheats MK, Ueda Y.Develop, implement, and monitor for adverse effects of, a novel hemoperfusion therapy in adult horses. Unassigned: A prospective, observational feasibility study using three healthy adult horses from the North Carolina State University teaching herd. Health status was determined by physical exam, complete blood count, coagulation panel, and serum biochemistry. Each horse was instrumented with a 14 Fr × 25 cm double-lumen temporary hemodialysis catheter and underwent a 240 min polymer-based hemoperfusion session. Horses were administered unfractionated heparin to maintain anti-coagulation ...
Effect of pregnancy on isolation efficiency and in vitro proliferation of equine peripheral-blood derived mesenchymal stromal cells.
Theriogenology    May 14, 2024   Volume 224 107-118 doi: 10.1016/j.theriogenology.2024.05.015
Mattei DN, Harman RM, Van de Walle GR, Smith R, Grivel JC, Abdelalim EM, Vinardell T.Mesenchymal stromal cells (MSCs) have regenerative and immunomodulatory potential and may be used to treat injured tissues. Pregnancy has been associated with increased MSCs in the peripheral circulation in multiple species, but to date, there are no reports on this matter in horses. This study aimed to evaluate the effect of pregnancy on isolation efficiency and proliferation capacity of equine MSCs derived from the peripheral blood (PB) of mares. Venous blood samples were collected at the 11th month of gestation and 1 month after delivery from clinically healthy Arabian mares that presented ...
Impacts of olfactory cues on equine feeding behavior.
Journal of equine veterinary science    May 13, 2024   Volume 138 105096 doi: 10.1016/j.jevs.2024.105096
Perry EB, Handlos GC, Fenton JM.Anise has demonstrated equine palatability but its olfactory effect is underexplored. The objective was to investigate the effect of the aroma of anise on consumptive behavior. Stock-type horses (n = 8) were used in a crossover 6-day preference test. Palatability stocks were utilized. Bowls containing oats were situated on plates holding gauze soaked with 0.375 ml of anise or corn oil (control). Variables included first diet sniffed (FS), first consumed (FC), first action (FA), and amount consumed (AC). Each trial was video-recorded. Behavior data were analyzed using chi square and Kruskal...
Radiographic analysis in Thoroughbreds reveals morphological changes in healthy maturing stifle joints and possible association between subchondral lesions and femoral condyle width.
American journal of veterinary research    May 13, 2024   1-11 doi: 10.2460/ajvr.23.12.0291
Wadbled L, Finck C, Santschi EM, Morehead JP, Fogarty U, Lemirre T, Beauchamp G, Richard H, Laverty S.Assess femorotibial features in foals with and without medial femoral condyle (MFC) subchondral radiolucencies (SR+ and SR-). Methods: 3 independent, sequential radiographic studies were performed. Study 1 retrospectively measured femorotibial morphological parameters in repository radiographs (SR- and SR+). Study 2 qualitatively compared drawings of intercondylar notch shape in postmortem radiographs (SR-). Study 3 prospectively measured femorotibial parameters in 1-month-old foals (SR-). In studies 1 and 3, 13 morphologic parameters were measured. Limb directional asymmetry was assessed in 2...
Surgical treatment of headshaking by removal of a paracondylar process fragment via modified hyovertebrotomy approach: A detailed anatomical and surgical description in an adult horse.
Veterinary surgery : VS    May 13, 2024   Volume 53, Issue 5 942-949 doi: 10.1111/vsu.14102
Spiesshofer P, Hawkins AE, Berner D, Previdelli RL, Fiske-Jackson AR.To describe, in detail, the relevant anatomy and surgical approach to access the paracondylar process (PCP) and report its application in a clinical case of headshaking. Methods: A seven-year-old, mixed breed mare. Methods: Experimental study/case report. Methods: A seven-year-old mixed breed mare was presented for investigation of acute onset progressing violent headshaking, resulting in the horse falling on multiple occasions. The horse was highly reactive to palpation over the right PCP. Standing computed tomographic (CT) investigation and ultrasonographic examination of the head detected a...
Corkscrew Technique for Extraction of Premolars and Molars in Standing Sedated Horses: Cadaveric Study and Clinical Cases.
Animals : an open access journal from MDPI    May 11, 2024   Volume 14, Issue 10 1439 doi: 10.3390/ani14101439
Ferreira JD, Méndez-Angulo JL.Several tooth extraction techniques are described in equine literature, and oral extraction techniques in standing sedated horses are popular among equine practitioners. The objectives of this study were to develop the corkscrew technique for cheek tooth extraction (CSET) in equine cadaver heads and evaluate this technique in clinical cases. We hypothesized that the CSET could be performed safely to extract cheek teeth in standing sedated horses. First, the CSET was attempted and developed in eight equine cadaver heads. Second, the CSET was performed in clinical cases between 2016 and 2020, an...
EFFECT OF CATTLE AND HORSE FECES STORAGE METHODS ON NEMATODE EGG VIABILITY AND SENSITIVITY FOR EGG HATCH TEST.
Experimental parasitology    May 10, 2024   108769 doi: 10.1016/j.exppara.2024.108769
Green de Freitas M, Gonçalves Lino Borges D, Henrique Conde M, Takemi Muchon Nakatani M, Francieli Tutija J, Fuzaro Scaléa GO, Reckziegel GH....The aim of the present study was to validate methods of stool sample conservation for the egg hatch test (EHT). This study involved the use of a bovine naturally infected predominantly by Cooperia spp. and one equine naturally infected predominantly by cyathostomins characterized as susceptible to benzimidazoles in the EHT. Fecal samples were submitted to three treatments: aerobic methods (anaerobic storage in plastic bottles, anaerobic storage in vacuum-sealed bags or aerobic storage in plastic bags), under two temperature conditions (room temperature and refrigeration) analyzed at four diffe...
Knowledge and perception of equine ticks and tick-borne diseases of Pennsylvania horse owners and caretakers.
Journal of equine veterinary science    May 10, 2024   105092 doi: 10.1016/j.jevs.2024.105092
Smarsh DN, Kenny LB, Spindler M, Poh KC, Machtinger ET.There is limited data on current knowledge of Pennsylvania horse caretakers on tick-borne diseases (TBDs), tick identification, and tick management practices. This study aimed to determine tick knowledge, concern, and management among Pennsylvania equine caretakers using an online survey. Descriptive statistics and one-way ANOVA tests were used to analyze data. The survey received 894 responses (539 completed) from Pennsylvania equine owners and caretakers. The largest proportion of respondents cared for 3-5 horses (31%), followed by 2 horses (27%). Veterinarian-confirmed diagnosis rates of tw...
Current insights into equine neuroaxonal dystrophy/equine degenerative myeloencephalopathy.
Veterinary journal (London, England : 1997)    May 10, 2024   Volume 305 106129 doi: 10.1016/j.tvjl.2024.106129
Young AE, Finno CJ.Equine neuroaxonal dystrophy/equine degenerative myeloencephalopathy (eNAD/EDM) is an inherited neurodegenerative disease associated with vitamin E deficiency in the first year of life. It is the second most common cause of spinal ataxia in horses euthanized for neurologic disease. Equine NAD/EDM is characterized by neurologic signs including a symmetric proprioceptive ataxia (> grade 2/5) and a wide-base stance at rest. There are currently no antemortem tests for eNAD/EDM in any breed. Conclusive diagnosis requires postmortem histologic evaluation of the brainstem and spinal cord at necropsy....