Abstract Botulism is a severe and often fatal disease in equine patients worldwide. Clostridium botulinum is a ubiquitous soil organism which produces a potent neurotoxin resulting in neuromuscular blockade and flaccid paralysis in affected animals. Definitive diagnosis is often impractical or impossible, leading to diagnosis and treatment based on clinical experience and presenting signs. Delay in case identification and treatment results in rapid deterioration of the patient. Treatment of recumbent equine botulism cases presents challenges due to patient size and requires intensive nursing care. This review summarises the current knowledge on equine botulism, including pathophysiology, clinical presentations, diagnostic and treatment options and prevention.