Dexamethasone Pulse Therapy (DPT),
Case story: I first came across this idea when my search for a cure for headshaking led me to autoimmune diseases, then multiple sclerosis (due to the demyelinization of nerves) and on to optic neuritis. Although I knew my horse did not have optic neuritis, a study showed that very high doses of corticosteroids for three days (pulsing) had a protective effect against new demyelization in multiple sclerosis patients . At the time I was not sure if demyelinization was a part of headshaking but thought it was worth following.
I had some positive results in the past using inhaled steroids and wanted to pursue the steroid route. The above study showed little side effects from the short-term high doses of steroids. The inhaled steroids that I used earlier gave a positive but very short effect on the symptoms associated with headshaking. I had tried low-dose steroids, and again they had some positive effects but relapse occurred. I originally had some veterinarians that were very well known suggest high-dose steroids but I became side-tracked with all the other options offered on the web sites for headshaking and remembered the associations with laminitis and steroids. I have since been advised by the University of Florida Veterinary School that such a short term of pulsing would greatly reduce any risks of side effects.
The response, after 7 months of trying every treatment offered, to the dexamethasone pulse therapy with my horse showed amazing results. After 9 months of once a month pulsing he has had only one isolated episode occur when he was extremely stressed. I gave him an early pulse and the symptoms went away the next day. He is back to normal. He has been showing and winning. Although this is in its early stages of investigation I feel because of the apparently obvious correlations between treatment and immediate results that this is a very promising treatment for headshaking.
The benefits of pulsed high-dose corticosteroid therapy are:
Low risk of side effects
Reduction of inflammatory mediators
Dexamethasone inhibits the production of nitric oxide, improves microcirculation, eliminates endotoxemia and cleans out free radicals
There are many studies showing the benefits of using corticosteroids for neuropathic pain and cluster headaches in humans.
My hope is that people can understand that this response appears to be dose and time dependant . Research as shown this dramatic response is not seen with low dose steroids given over a longer period. Also important to understand is that the short duration of use, of just three days, greatly reduces the side effects. I also hope that a better treatment can be found that has no side effects at all and is just as effective and gives permanent results.
I do feel that this treatment, besides relieving the horse from intense pain, offers us a glimpse into the pathways that might help us uncover the origin of the pain.
All doses of medications are given by a qualified veterinarian.
"Do not go where the path may lead. Go instead where there is no path and leave a trail".
 Beck, R., Cleary, P., Trobe, J., Kaufman, D., Kupersmith M., Paty, D., Brown, C., The Effect of Corticosteriods for Acute Optic Neuritis on the Subsequent Development of Multiple Sclerosis, The New England Journal of Medicine, 1993, No 24, Vol 329:1764-1769.
 Goadsby, PJ., Neuromodulary Approaches to the Treatment of Trigeminal Autonomic Cephalagias TACs)