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Horses will shake their heads for a range of reasons, but vets recognise that some of the time the headshaking signs are associated with diseases and nerve problems in their heads, causing discomfort and resulting in characteristic pattern of headshaking signs.
Headshaking horses show a pattern of signs that can include some or all of the following:
– Vertical (up and down), horizontal (side to side) or rotationary (round and round) flicking of the head
– Nostril twitching or grimacing
– Nose twitching and lip smacking
– Scrubbing the nose on the floor, against their legs, on the rider’s feet, or stable walls
– Snorting (obviously all horses can snort, but where this is exaggerated it could be signs of headshaking)
– Sometimes it appears very dramatically and the horse behaves as if an insect has flown into the ear or up their nose
These headshaking signs are sometimes caused by infections, cysts, growths, and inflammation in the head that damage the trigeminal nerve that is responsible for communicating facial sensation to the brain. More often though, the signs are related to a problem with the function of the nerve itself and we call these cases “trigeminal-mediated headshakers”.
Horses usually develop the condition between the ages of 5 and 12 years. It can start rapidly and severely, or it can begin with very mild signs and gradually get worse over months and years. Some horses only show signs during the spring and summer, and others have signs that persist all year.
The use of computed tomography (CT) has revolutionised our ability to investigate headshaking cases. It enables us to rule out other diseases, and make a confident and accurate diagnosis of trigeminal-mediated headshaking. If you suspect your horse is showing headshaking signs, your vets are likely to recommend this important step in the investigation of headshaking signs.
There is an evidence-based non-invasive treatment option for trigeminal-mediated headshaking cases called PENS therapy. This PENS treatment has a good success rate in returning horses back to their previous athletic activities and (other than the sedation used during the procedure) has no withdrawal time prior to affiliated competition.
More information on PENS can be found here: https://liphookequinehospital.co.uk/…/Trigeminal-mediated-h…
Victoria South and Jamie Prutton, two of our equine internal medicine specialists, have a wealth of experience in managing headshaking cases, and are involved in international research projects in this area. They would be delighted to talk through the diagnostic steps and treatment options, so if you have a suspected headshaker case and would like to find out more then please contact the Hospital for more information on 01428 723594 or via email at post@theleh.co.uk.
How does the seasonal influence on the pituitary gland influence the diagnosis of PPID at this time of the year? And how does it impact follow-up blood samples in cases that were previously under control? What happens if you try to start pergolide treatment in July or August?
Let us take the stress out of managing your PPID cases – download our latest (free) podcast with Victoria South and Andy Durham who discuss what happens to our basal ACTH reference intervals at this time of the year, and chat through some common case scenarios that are affected by the pituitary hyperactivity observed at this time of the year – Seasonal PPID Podcast
We have upgraded our Endocrinology Analysers and are proud to introduce the Immulite 2000 xpi System.
Our driving ethos at Liphook has always been to stay ahead of the game and offer the latest and best to all of our laboratory users. Thus, we have recently purchased two Siemens Immulite 2000 xpi analysers, the newest and most proficient chemiluminescent immunoassay system available in this format which supersedes the older Immulite 1000 system used by most other labs. These new analysers allow greater precision, accuracy and throughput and, given that we have duplicate machines, this means that we can guarantee uninterrupted output of results even in the unlikely event of a machine malfunction.
It is well recognised that different assays and analysers generally return different results, and even the change from Immulite 1000 to Immulite 2000 xpi is no different in this respect. We have spent the past 6 months validating the new analysers and re-establishing appropriate cutoffs for diagnostic use and so you will see slight differences on forthcoming laboratory reports.
We apologise as I’m sure we’d all prefer to stay with our previous familiar values, but this change not only improves test reliability, but will in time be inevitable as the old Immulite 1000 system is withdrawn. We felt that as reference intervals (for ACTH at least) are about to change with the season in any case, this was the best time to implement this change. Should you require any assistance with interpretation or comparison with previous results then don’t hesitate to contact us to discuss.
Effects on ACTH reporting
As a general guideline the newly generated ACTH values will be slightly lower than previously (by around -10%) meaning lower cutoffs. In general terms this means a cutoff between 23-26 pg/mL for most of the year, rising slowly from July to a peak of 50 pg/mL in late September and returning to baseline by mid-November. Liphook Equine hospital remains the only laboratory internationally with valid ACTH reference ranges available for every week of the year, allowing greater accuracy of interpretation.
Effects on Insulin reporting
As a general guideline the newly generated insulin values will be higher than previously (by around +30%) meaning higher cutoffs. Resting insulin values in normal horses are expected to be no higher than 30-50 mU/L depending on the diet, and the response to 0.45 mL/kg Karo Light Corn Syrup should be no higher than 63 mU/L between 60-90 mins post-dosing.
On the 25thJune 2018 a new law was set requiring all horses to be microchipped. From October 2020 it will be compulsory for all horse owners to microchip their horses, ponies and donkeys.
Click on the following link for further information:
https://www.gov.uk/government/news/compulsory-microchipping-to-improve-horse-welfare
We appreciate that is can be tricky to keep in touch with the latest publications on endocrinopathic laminitis especially those relevant to the diagnostic tests that we use in practice. We have produced this handy summary of the best evidence-based protocol for the Karo Light Challenge Test. Please click here to view the protocol.
We currently have vacancies for the following positions:
Part–Time Weekend Groom
Maternity Cover Yard Nurse
Temporary Handyman
For more information, please click on the following link:
https://liphookequinehospital.co.uk/job-opportunities
We are all now recognising that most cases of liver disease that we encounter are part of a wider outbreak amongst herd-mates, even if the others appear externally healthy. This suggests a common toxin or infectious aetiology. It is useful to rule out “old favourites” such as ragwort by biopsy. Fluke is rare and almost impossible to rule out as no antemortem tests are reliable.
Work performed at Liphook over the last few years has identified fumonisin B1 contamination of forage as a possible cause of some outbreaks and international work looking at various causes of viral hepatitis in horses has identified a number of candidates including equine Hepacivirus, equine Pegivirus, Theiler’s disease associated virus and equine Parvovirus.
See Cornell University Laboratory website:
https://ahdc.vet.cornell.edu/news/equinehepatitis.cfm
and recent publication describing equine Parvovirus: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5782890/pdf/17-1031.pdf
Continued work at Liphook has identified equine Parvovirus in some horses with liver disease and we hope to offer this, and other, new PCR assays shortly.
What’s inside this issue:
– Spring: Points for you to consider
– Out and about with LEH
– What is Bone Scan Imaging?
– Laboratory News – Same day Ringworm tests and free cushings tests available
– Dentistry Feature on Equine Odontoclastic Tooth Resorption and Hypercementosis (EOTRH), plus a case study on EOTRH
– Preparing Your Mare For Breeding
To sign up to our e-newsletter and keep up to date with news and events, plus special offers and healthcare information about your horse, pony and donkey, please email emily.hinton@theleh.co.uk.
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