Equine grass sickness (EGS) is recognized as a debilitating and predominantly fatal neurodegenerative disease affecting grazing equids. The gastrointestinal tract is the most severely affected body system, resulting in the main clinical signs of colic (acute grass sickness), weight loss, or dysphagia (chronic grass sickness). EGS predominantly occurs within Great Britain, although it is also recognized in regions of mainland Europe, and mainly affects young horses with access to pasture in the springtime. There is strong evidence of an association between EGS and the type C toxins produced by the bacterium Clostridium botulinum. This article covers the clinical aspects, epidemiology, and global distribution of EGS, along with comparisons with botulism and developments in disease prevention.