Clinical signs of equine neurologic disease can progress quickly and pose safety risks. | iStockSubtle changes in your horses gait, posture, or behavior can mark the earliest signs of neurologic disease. These conditions can progress quickly and pose serious safety risks. Early recognition, systematic diagnosis, and thoughtful management therefore remain crucial, said Sarah Colmer, VMD, Dipl. ACVIM, neurology fellow at the University of Pennsylvanias New Bolton Center, in Kennett Square, during her presentation at the 2025 American Association of Equine Practitioners Convention, held Dec. 6-10, in Denver, Colorado.Veterinarians commonly identify incoordination, or ataxia, as one of the most frequent presenting complaints. Horses might stumble, drag their toes, cross limbs, or place their feet inconsistently, particularly when turning, backing or navigating uneven footing. Colmer noted that affected horses can show hind-limb weakness, sway while standing, or struggle to rise after lying down. In some cases muscle asymmetry, head tilt, or changes in attitude also raise concern for neurologic involvement.The Equine Neurologic ExaminationBecause these clinical signs can resemble lameness or musculoskeletal pain, Colmer stressed the importance of conducting a complete neurologic examination. Veterinarians typically evaluate posture, muscling, and cranial nerve function before observing the horse at the walk on straight lines, circles, and slopes. This structured exam allows clinicians to determine whether the nervous system may be involved and helps localize the lesion to the brain, spinal cord, and/or peripheral nerves, she said.Diagnosing Neurologic Problems in HorsesOnce veterinarians identify a neurologic deficit, they can use targeted diagnostics to identify the specific condition based on characteristic patterns of nervous system involvement. Imaging can play a central role, particularly when clinicians suspect spinal cord compression. Radiographs and advanced imaging can help them identify vertebral malformations or degenerative joint disease associated with cervical vertebral stenotic myelopathy, commonly known as wobbler syndrome. Colmer said improved access to standing computed tomography (CT) has enhanced veterinarians ability to evaluate some aspects of the cervical spine without general anesthesia.Infectious neurologic diseases remain a significant concern in practice. Equine protozoal myeloencephalitis (EPM, caused by Sarcocystis neurona or Neospora hughesi) can present with asymmetric signs, including ataxia, cranial nerve abnormalities, and muscle wasting, reflecting the parasites tendency to cause uneven damage within the central or peripheral nervous system, said Colmer. Accurate diagnosis requires more than a blood test to be confident. Comparing antibody levels in blood and cerebrospinal fluid helps veterinarians distinguish exposure from active disease. Treatment response varies and could depend on factors such as severity at diagnosis, duration of clinical signs, and the horses overall health, she added.Managing Neurologic Disease in HorsesManagement strategies depend on the underlying cause, severity of disease, and progression of clinical signs, said Colmer. Treatment might include targeted antimicrobial or antiprotozoal medications, anti-inflammatory drugs and controlled exercise or stall rest. She emphasized that safety remains a primary concern, particularly for (and around) horses with moderate to severe ataxia. Adjusting the horses environment, improving footing, and limiting situations that increase fall risk can reduce injury to both horses and handlers.Take-Home MessageWhile some equine neurologic conditions carry a guarded prognosis, Colmer said early detection and appropriate intervention can stabilize many cases and improve quality of life and prognosis. Consistent monitoring and clear communication between veterinarians and horse owners remain critical components of long-term management.