CASE STUDY: Equine Protozoal Myeloencephalitis (EPM) – Rehabilitation

Equine protozoal myeloencephalitis (EPM) is a feared diagnosis among horse owners. This infection with a microscopic organism spread by possums can cause devastating disability because the protozoa attacks the brain and spinal cord — which run every system in the body. Almost any type of symptom is possible but the most common symptoms are loss of hind end strength and coordination. Many horses never return to their pre-infection level of function despite treatment because although the medications inhibit the protozoa — a necessary step — they cannot repair the brain and spinal cord damage left behind. If your horse is “stuck” after treatment and continues to exhibit symptoms, then these symptoms indicate persistent nervous system damage. This damage rarely goes away on its own. Repeated treatment will not fix it because once your horse has been treated for 60 or 90 days, the chance that there are lingering protozoa present is zero. The problem at this point is not the protozoa — it is the damage they left behind.

The key to effective EPM rehabilitation is targeted nervous system support so that damaged areas of the nervous system repair themselves and the horse regains lost function. These repairs are accomplished by using specific supplements that stimulate release of nerve growth factor — the chemical signal to the nervous system to regenerate and repair. Specific supplements that control inflammation in the nervous system also often are necessary.

The worst case EPM scenario is an older horse who is large (more nervous system that has sustained damage) and went undiagnosed for a period of time during which damage continued to accumulate.

This is the situation in which Manny’s owner found herself. Manny was purchased in extremely poor condition from a horse trader.

Manny, a 14 year old Belgian, in extremely poor body condition at purchase from a horse trader.

He is a 14 year old 17 hand Belgian — a large draft breed. In the picture above, he is missing at least 100 lbs of muscle. Sparse information was provided about his history. His poor condition at purchase, however, suggested that he was already ill as one common EPM symptom is full body muscle wasting.

During their first few months together although he started to put his weight back on Manny struggled with an assortment of health issues indicating his immune system was struggling. Then he started to lose control of his hindquarters. Below is a video of his drifting hind end in August 2023.

Manny is losing control of his hindquarters in August 2023; note the drift to the right.

His EPM titer was not very high but symptoms trump the titer numbers with EPM because horses with weak immune systems may not be able to mount a robust titer (for detailed discussion regarding how to interpret titer numbers, see the EPM section under Resources).

Treatment was initiated and an aggressive nervous system restoration protocol was implemented. This protocol included an anti-inflammatory diet high in gut-friendly, easily-digested protein to restore his muscle mass as well as high doses of nerve growth factor releasing supplements and nervous system inflammation controlling supplements. His protocol also involved physical rehabilitation in the form of a wearable rehab device that helps EPM horses recalibrate how they use their body and exercises to improve his strength. It took several months and Manny needed a great deal of support but his owner stayed with the program — and the videos tell the story… Below is Manny’s evolution from August to December.

It is also a love story. As Manny and his owner moved into and through his recovery process, their bond deepened and strengthened and became more than a horse who desperately needed help from a kind and committed human.

“He is the love of my life,” she says.


Here is Manny in Spring 2024, under saddle and thriving — a worst case scenario that turned into a fairy tale.

Manny under saddle in Spring 2024.

Need help with an EPM horse? Everything owners need to understand about EPM is in the EPM section under Resources and also is covered in a recorded webinar (see Webinars or click the webinar button on the home page). Key information is also in my EPM Facebook group in the Files section — see the group called EPM: Whole Horse Rehabilitation.

For rehab help, please message, email the email address on the website, or book a consultation. Let’s get your horse back.

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