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I have a thoroughbred cross gelding, I have looked after him like a child , we have a brilliant relationship and is so gentle. he is 17 years old and after many tests have been told he has equine motor neurones. it has devastated me as he cannot be ridden any more ,as he trips up a lot, and generally his walking can be pretty bad , but left to his own devices makes his way around the paddock in his own way.

My question is, when do I draw the line in having him put to sleep. he eats well , stays out in the day, stabled at night, but I have to watch him at the end of the garden just staring down the drive waiting for me to take him out. it breaks my heart to turn him away as he loves going out. and I feel he has no quality of life being stuck in a 2 acre paddock for the rest of his life. am I being selfish in putting him to sleep while he has a bit of dignity or do I wait until it gets to the stage where I find him that he can hardly walk. I am being torn apart in what to do , as there is no cure for him , only being on vitamin E serium. which is £120 a tub which thankfully the insurance pay for.

I would be most grateful for much needed advice if anybody knows anything on this dreadful decease.

Derek C Knottenbelt BVM&S, DVMS, DipECEIM, MRCVS from the Philip Leverhulme Hospital replies.

Equine Motor Neuron Disease is an unusual condition that can affect horses of all ages and types. In America, where it was first diagnosed in the mid 80-'s the condition is strongly associated with an "indoor" life. We have also seen cases in UK (and in Europe too incidentally!) and almost all the affected horses we have seen have been outside and fed and managed well.

This begs the question of course, whether Vitamin E is the cause of the problem at all. Nevertheless, because it is a progressive neurological degenerative disease, we feel obliged to use it in case it helps. Realistically however it is likely that this is simply a mechanism for providing free-radicle scavenger drugs to stop the progression.

You describe stumbling as a major part of the problem and certainly that is possible. The main description of the clinical signs of EMD is "the horse moves better than it stands". This is simply because when the horse is standing it needs to keep the antigravity muscles in permanent activity and so with EMD they get tired quickly. This shows as muscle trembling particularly in the muscles behind the shoulder (the triceps) and in front of the stifle (the quadriceps).

Affected horses often also show prominent muscle wasting of these muscles as well as the jaw muscles (on the side of the face and over the top of the head). Because the muscles get tired quickly, the horse usually spends a lot of time lying down and may have
difficulty in getting down and getting up after a rest. They continue to eat well throughout but they do lose weight overall.

Because the condition is very variable the signs can be mild or severe. The more severe cases show ataxia - that is they make mistakes with their feet; they may have difficulty turning and may plait quite strongly and may even knuckle over on the fetlocks. One of the common diseases that looks like it is laminitis in a few cases because the horse continually shifts weight from one leg to the other and they often stand with all 4 feet together while they shift weight. They sometimes have a mildly alarmed expression - they look over alert in a few cases. Commonly they have mild blood evidence of ongoing muscle damage - this simply reflects the wasting and the extra load that some muscles have to take while others waste away.

In your case where stumbling is the main sign I think the vet will have eliminated other causes of stumbling in particular such as joint and foot problems, but older horses are inclined to do this anyway -especially the bigger horses. This can be a neurological problem and it can be EMD, but to help you may be able to use set back, four point shoes in front or a strong rolled toe shoe so that the break over is earlier.

A horse that stumbles a lot is dangerous for both itself and the rider of course.

With EMD the outlook is very uncertain. Some cases have stabilised at a level that is acceptable but others are progressive and gradually get worse.

You ask about "when is enough".. that decision is entirely yours. If the horse is in pain (EMD cases are not usually painful) or is injuring
himself (stumbling can cause severe discomfort and distress in some cases) then you have to ask if anything can be done to alleviate the problem. If yes. and you want to do that then GO FOR IT. If the current state is not acceptable (to you and the horse) and there is nothing that can be done about it, then the decision is clear. I know this is a short chain of command and may seem to be brutal but if you carefully consider what I have said you will see the merit of it.

The long and the short of it is that the EMD horse is often quite happy but does get to the point where he cannot be what he
wants to be.. i.e. a riding horse that can gallop safely around the field when he wants to. Then a hard decision is taken. Horses have no concept of tomorrow - they don't look forward to the summer at grass - each day is taken as it comes so you should not worry about making that decision for him.

I hope this helps and that you will in the end have bank of happy memories rather than a grotty day at the end.

Derek C Knottenbelt BVM&S, DVMS, DipECEIM, MRCVS
Philip Leverhulme Hospital
University of Liverpool
Leahurst
Neston