The effects of prolonged endurance exercise on the neurological system in horses

Horses compete routinely in endurance-type activities. Many of the various pathophysiological mechanisms which arise during endurance exercise have implications for the health and function of the neurological system. The development of centrally-mediated fatigue is a normal homeostatic physiological event with several possible mechanisms. Development of pathophysiological phenomena such as cerebral oedema may be near-terminal events during or after endurance exhaustion. Cellular damage resulting in cytotoxic cerebral oedema may result from decreases in circulating blood volume (dehydration), blood pressure, oxygen, and glucose, or increases in brain temperature. Vasogenic cerebral oedema arises from changes in cerebral vascular perfusion, tone, and permeability. Increased vascular permeability results from increased brain temperature, poor vascular integrity due to severe dehydration, disseminated intravascular coagulation due to hemoconcentration or endotoxemia, and iatrogenic overhydration during therapy. Clinical signs of intracranial disease after endurance exercise include staggering, shaking, ataxia, paresis, poor tongue tone, facial twitching, collapse, recumbency, seizures, and death. Treatment should include active and aggressive cooling, intravenous polyionic fluids, acid-base imbalance correction, intravenous glucose and calcium supplementation, non-steroidal anti-inflammatory agents once the patient is better hydrated, intranasal oxygen therapy if practicable, and achievement of a non-dependent head posture to prevent jugular venous hypertension and further increases in intracranial pressure. The prognosis for central fatigue is good with appropriate supportive care, but the prognosis for successful treatment of cerebral oedema must be considered guarded at best. Prevention is critical and must be through incorporation of mandatory rest stops with sufficient length and veterinary monitoring to allow prevention and detection of exhaustion, excessive dehydration, and neurological signs. Management flexibility in shortening or postponing rides in hot and humid conditions, mandated use of aggressive cooling techniques, and more restrictive entry criteria for upper level Fédération Equestre Internationale races should all be considered as viable options for optimising the safety of endurance horses.