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Advanced dressage horse seems to have developed narcolepsy…

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Advanced dressage horse seems to...
Advanced dressage horse seems to have developed narcolepsy aged 8 - no collapse while ridden, just while resting in stable, good response to Periactin but i can find very little info on equine narcolepsy or the use of Periactin on the web. Is it legal, or are his competiiton days over? any other suggestions?
Submitted: 8 years ago.Category: Horse Veterinary
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Answered in 16 minutes by:
6/25/2010
Horse Veterinarian: Dr. Loretta, Horse Veterinarian replied 8 years ago
Dr. Loretta
Dr. Loretta, Horse Veterinarian
Category: Horse Veterinary
Satisfied Customers: 28,360
Experience: 25 years of experience in treating horses.
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Hi there.

The use of Periactin is controversial and has helped some horses but not others. This drug us legal but is being used off label since it is generally used for migraines and other issues in humans. Research has shown good results with this medication but, like I said before, it does not work on all horses. This is probably due to the fact that in horses, this condition cannot be differentiated between the types of narcolepsy as it can in humans.

It is common in horses with this condition to only have these periods during inactivity or being lead somewhere or bathed after exercise. The most feared part of this condition is Cataplexy which is dangerous to the horse because if its size and causes the horse to collapse.

Treatments including periactine and Imiprimaine have inconsistent results so this has not been curative. Horses affected with this are always prone to this condition and you will not be comfortable doing exercise or competition on this horse because even though the attacks are usually during rest, owners report episodes during exercise as well.

It is important that you have Lloyd examined by a Veterinary Neurologist. If you are close to a teaching veterinary hospital, this would be the best since they will be more current with the research that is going on with this condition.
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Customer reply replied 8 years ago
So the horse is still legal to compete under FEI rules on Periactin?
Horse Veterinarian: Dr. Loretta, Horse Veterinarian replied 8 years ago
HI again.

I am not familiar with the FEI rules but I do know that they are VERY strict about medications and I would suspect that this may not be an accepted medication. I have looked online to see if this is acceptable but I have not found anything. The only thing you can do is to contact them directly and ask about this particular medication. I would be surprised if this was allowed, however, since even Butazolidin or any antibiotics are not allowed.
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Horse Veterinarian: Dr. Mike, Equine Veterinarian replied 8 years ago
Dr. Mike
Dr. Mike, Equine Veterinarian
Category: Horse Veterinary
Satisfied Customers: 560
Experience: 25 years in private equine practice.
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Periactin (cyproheptadine) is not listed specifically on the FEI list of banned substances, but other antihistamines are, and thus periactin would be banned under the clause prohibiting "Any other substances with a similar chemical structure or a similar biological effect".

I would second the recommendation for a thorough neurologic evaluation, preferably by someone with some experience in behavioral neurology, as narcolepsy is exquisitely rare in horses (other than miniatures). I suspect Lloyd is manifesting symptoms of sleep deprivation rather than narcolepsy, but a thorough workup is indicated.

DrMike
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Horse Veterinarian: Dr. Loretta, Horse Veterinarian replied 8 years ago
I thanks Dr. Mike for his addition since I am not familiar with the rules. It confirms my reasoning that Cyproheptadine would not be allowed during competition. I was questioned severely after a competition because my horse had been on SMZ's 5 weeks prior to competition and this showed up on the urinalysis. These testing procedures are extremely sensitive and will pick up many medications.

have Lloyd examined by the Neurologist and then you will be more comfortable about going back into competition.

Have a Great day!!
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Customer reply replied 8 years ago

Thanks so much for the info so far, which has been very helpful - sorry to be a pain, but there is so little about this condition on the web I am keen to know more, and while I have of course consulted my vet (who prescribed the periactin) he admits this is so rare in horses, he has little experience to draw on. The horse is not insured, so while I recognise the need for expert advice, I have a few more questions before I bite the bullet and consult an equine neurologist.

What exactly is the effect of periactin? How would I know if the horse simply suffering 'sleep deprivation' or some other virus, rather than narcolepsy, as suggested by Dr Mike? periactin seems to have effected an improvement in symptoms, but could this be due to other causes? isn't it rather strange that an otherwise healthy and active 7 yr old competion horse should have developed these symptoms in a matter of weeks, when blood tests show nothing untoward? In fact he has never performed better in his ridden work and i am (was...) delighted with him - but all to no avail if he can't compete! what is the withdrawal time on periactin if I decide to compete? And what are the likely effects of long term use, given he is a young horse? is he likely to need higher doses as the years go by? what indeed is the difinitive 'test' for narcolepesy?

Horse Veterinarian: Dr. Loretta, Horse Veterinarian replied 8 years ago
HI again.

I certainly understand your concerns and this is a very difficult disease to understand much less diagnose and treat.

There is a definitive test for this disease and that is the administration of physostigmine salicylate and this will cause an episode within 3-10 minutes. I have not performed this test myself but have seen and heard of it at seminars. Your vet would have to get the specifics from a veterinary Neurologist that would more commonly use this.

Treatment has been Imipramine and I am not that familiar with the use of Periactin for this disease. From what I have read,. it is a seratonin inhibitor which means that it has effects on the brain. This is an off label use so this has not been studied in horses so the withdrawal time would be in question. This medication should be stepped down if you plan om taking Lloyd off this drug.

As far as younger horses, some will have less frequent episodes until they do not have any more while this can also continue for life. This is extremely rare condition and I have only seen 2 cases in my 25+ years of practice so your vet will have to rely on the Neurologist for help.

Does that help?
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Customer reply replied 8 years ago
Very interesting - periactin ceased to work after 10 days and horse collapsed 3 times in one day during stable rest, after a perceived improved. However, horse also had steroid injection for adverse reaction to a strong fly repellent 10 days previous (always been sensitive skinned) and improved massively (ie no collapses at all) for the five days the steroids would be within his system. is it possible steroids could have eased the 'narcolepsy' rather than the periactin? or does it seem more likely we are looking at another condition here, possibly a tumour, which responded to the steroid treatment? From what I have researched, it seems unheard of that a fit healthy Warmblood 8 yr old competition horse should suddenly develop acute narcolepsy within six weeks? given blood tests are negative, ruling our a virus, any other ideas? The horse is not insured, otherwise I would indeed be persuing your advice of a full neurological workup.
Horse Veterinarian: Dr. Loretta, Horse Veterinarian replied 8 years ago
Hi again.

Steroids will reduce inflammation in certain areas of the brain or other places of neurologic involvement so it is a possibility that the steroids may have caused improvement. This still could be a brain tumor or other Central nervous system damage that will respond to an anti inflammatory.

You will not know for sure without a work up and I still fear that these episodes may worsen making Lloyd dangerous for you to be competing on. I certainly understand the expense that this would entail but it may give you peace of mind.
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