Equine Polysaccharide Storage Myopathy (EPSM):

Basic Etiology & Nutritional Considerations

Lee Ann Swenson, MS, BSc, CEMMT
 EPSM Definition

• “Monday Morning Disease”

• “Tying-Up”
• Actually a Myositis = Muscle Inflammation

 Exertional Rhabdomyolysis (ER)

– EPSM is a distinct subtype of ER
– a.k.a. PSSM
 Tying-Up / ER

General Symptoms
• Horse shows signs of discomfort within the first
minutes of exercise or after some time during
work
• Mild stiffness to severe cramping
• Range from performance inhibition to severe
morbidity
• Numerous theories as to reason for occurrence
of ER
• EPSM = one defined subtype
 EPSM Etiology

Normal Muscle Energy Production

• Requires large amounts of energy
• At initiation of work: most efficiently supplied via
aerobic metabolism
• At greater exertion: energy must be generated
more quickly and anaerobic metabolism begins
 Muscle Metabolism

Charbohydrates Fats

Glycogen or Glucose Volatile Fatty Free Fatty

Acids Acids

Anaerobic Metabolism Aerobic Metabolism

Muscle Cell Muscle Cell

Without Oxygen With Oxygen

Toxic By-Product:
Non-Toxic By-Products:
Lactic Acid
Water & Co2

ENERGY FOR PERFORMANCE

(ATP Energy Molecules)

Anaerobic Exercise Aerobic Exercise

 EPSM Etiology

In EPSM: Excess stored glycogen in muscles

• Metabolized earlier in the sequence than usual
• i.e. earlier initiation of anaerobic metabolism
 Earlier and more significant production of toxic wastes
(lactic acid etc.)
Hypothesized to be due to:
• Defect in glycogen metabolic pathway
• Effected horses cannot use carbohydrates correctly for
energy production on a normal scale
• May also be due to an increased glucose uptake as
demonstrated by exaggerated insulin responses
 EPSM Relevance

Epidemiology
• Commonly seen in many breeds
– Including Appaloososas, Arabians, paints,
standardbreds, TB
– Best characterized in draft breeds
• As high as 50%
– Evidence that EPSM is hereditary in certain lines of
QHs
 EPSM Relevance

EPSM is a True Management Issue

• Cause of severe muscle wasting & weakness
• Repeated tying-up
• Poor athletic performance
• Abnormal hind limb gaits
• Horses can go down due to weakness
– During work, foaling, or even at rest
• Problems during anesthesia
 EPSM Clinical Signs & Symptoms
Loss of muscle mass/conditioning,
- especially in the shoulder or hindquarters
Abnormal gait due to mechanical lameness in one or both hind legs
• Shivers (hind legs periodically bent and held up for several seconds)
• Fibrotic myopathy-like (legs have a short “stabby” action, with little or no bend in the
hock and stifle
• Locking stifle
Trembling, especially after exercise
Difficulty rising, backing, or reluctance to back
Lack of energy
Poor performance
Reluctance to pick up feet for shoeing
Lifting or stamping of hind limbs when standing
Episodes of colic, especially after exercise
Slightly stiff, awkward, or short behind
Repeated tying up
Lying down suddenly, unable to rise
 EPSM Diagnosis Issues

Observation Not Definitive

• EPSM horses may appear completely normal for
years
• EPSM can mimic clinical symptoms of numerous
conditions
 EPSM “Look-Alike” Conditions
Equine Protozoal Often exhibits atrophy of the hind end, as well as rear-limb weakness.
Myeloencephalitis
(EPM)
Equine Motor Neuron Causes profound muscle atrophy, weakness, trembling, and slight increases in blood
Disease (EMND) levels of muscle enzymes. The weakness is most profound in the muscles used for
maintaining posture, horses are most distressed when standing, and will shift
weight frequently.

Lyme Disease Horses with Lyme disease have a vague shifting-leg lameness and a stiff gait, and
appear to have pain all over.
Colic Repeated episodes oif colic, especially after exercise may be a sign of EPSM. However
careful examination of the horse must be done to distinguish between colic due to
GI distress and muscle pain due to EPSM.

Poor Mover A short, stiff, stabbing gait (“pony-mover”) must be determined not to be related to
conformational issues.
Hock Problems, Arthritis Flexion tests, x-rays, ultrasound, and joint blocks can distinguish a joint problem from
EPSM.
Behavioral Problems/ Back EPSM horses may be difficult under saddle and may resent being asked to canter or
Soreness carry themselves forward. This may be mistaken for back soreness, poor saddle fit,
or behavior problems.
 EPSM Definitive Diagnosis

Muscle Biopsy
• Sample taken from semimembranosis or
semitendinosis muscle under sedation
• Sent for analysis
– Distinctive abnormal staining of fast twitch muscle
fibers
– muscle cell death
– infiltration of white cells
– regenerative fibers and atrophy of type II fiber cells
 EPSM Management & Prevention

Immediate Intervention – as with other causes of tying-up

• Hydration 7 kidney function via iv fluid therapy
• Acepromazine (reduce anxiety & increase blood flow)
• NSAIDS (banamine/bute) for pain & inflammation
• Rest & hand walking once initial stiffness subsides
 EPSM Management & Prevention
Prevention of tying-up in EPSM Horses
Proactive Diet Program
• EPSM horse are unable to obtain adequate muscle
energy from CHO
Low-Carb, High-Fat Diet
 Eliminate sweet feed, grains, most pelleted feeds
 Replace energy with fat
• Vegetable oil (corn, canola, soy)
• Powdered animal fat
• Commercial high-fat feeds
 Forage remains the same
 EPSM Diet

• Free-choice hay or quality forage

• Feed:
– Low carbohydrate
– one pound of fat per 1,000 lbs body weight
– 20-25% of total daily calories from fat
• +/- Vitamin E and selenium in deficient areas to
provide antioxidants
 EPSM Diet

Simplest EPSM Diet

• Replace grain with alfalfa pellets
• + Vegetable oil

Commercial EPSM Diets

• Buckeye Feeds: Grow’N Win, Ultimate Finish, +
corn oil
 EPSM Diet

EPSM Diet- highly effective when started in early stages

• EPSM horses have demonstrated:
– improved muscle mass
– increased energy
– perform athletically with no muscle damage
• May decrease, delay, or prevent signs of EPSM
• Safe for any horse
• May even be a healthy alternative
• Can be used as a test “diagnostic” to determine possible
EPSM
 EPSM Exercise

• Gradual Training Program

• Adequate Daily Exercise
• Ample Turnout
Objective: Increase the oxidative capacity of the
muscle
– The more aerobic metabolism can be used, the less
use of glycogen and lactic acid build up.
– A more aerobically fit EPSM horse may have fewer
clinical signs in the long term
 EPSM Exercise

Sample Program: EPSM Horse Returning to Work

• Gradual lunge work 5 min Day 1
• Gradually increasing each day for 3 weeks
• Under saddle week 4
Ongoing:
• Minimize stall confinement > 12 hours/day
• Minimize long trailer rides
• Maintain CONSISTENT work schedule
• Work must be regular and warm-ups gradual
 EPSM Conclusion
EPSM
= one possible reason for “Monday Morning
Disease” or tying-up
• A true performance issue for certain horses
Optimal Management:
• Rule out other possible conditions with vet
• When EPSM is suspected
– Low-carb/high-fat diet
– Consistent gradual work schedule
• Can continue productive work careers in pullling,
pleasure, dressage, and hunter jumper events