EPM Protocol

What the protocol aims to address

• EPM is caused by protozoa (e.g. Sarcocystis neurona) entering the central nervous system. Clinical disease often appears when the immune system is suppressed or compromised.

• Many horses with EPM also have concurrent parasitism, e.g. strongyle larvae, especially migrating L4 larvae around arteries (anterior mesenteric artery) and elsewhere, which stresses the immune system. thewholehorse.com+2IVC Journal+2

• The idea is that by reducing parasite burden, boosting immune function, improving nutrition, and using some herbal or conventional anti-protozoal agents (or in some cases pharmaceuticals), the horse’s body can better fight off the protozoal infection and recover.

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Key components of the protocol

Here are the steps and components as described by Dr. Lu Ann Groves DVM (and others) in the natural / integrative medicine community. thewholehorse.com+1

Step	What’s done	Purpose / Notes
1. Deworming / Parasite reduction	- Start with Ivermectin if the horse hasn’t been dewormed in last ~4 months. This gives a “slow kill” to avoid risk of impaction if worm load is high. IVC Journal   - Then a Panacur PowerPak (fenbendazole, double dose for 5 days) to “paralyze” L4 larvae. thewholehorse.com+1   - After waiting ~10 days, give Quest Plus (moxidectin + praziquantel) at full weight dose to kill the paralyzed larvae. IVC Journal+1   - Then after another ~10 days, give regular Quest to catch any remaining L4 larvae. IVC Journal
2. Immune system & Digestive support	- During deworming and afterward, feed immune-boosting / gut-healing supplements: “Karbo Pellets” & “Epic Liquid” are mentioned. These are formulated to support digestive health, immune function, etc. IVC Journal+1   - Use of Chlorella (broken cell wall) to remove heavy metals & provide nutrient / detox support. thewholehorse.com+1   - Keep horse under low stress; good nutrition; good dental care; quality forage; reduce grain if problematic. SecondVet+1
3. Herbal / Anti-Protozoal Agents	- After deworming, wait ~5 days, then start Sefacon (an herbal product claimed to kill protozoa) for ~10 days. Dosing adjusted for weight; may use double dose in large horses. IVC Journal+1   - In more severe / acute cases (“very ataxic / wobbly”) some use Marquis (a conventional anti-protozoal, = ponazuril) to bring protozoal burden down quickly before beginning herbal protocol. IVC Journal+1
4. Maintenance / Ongoing monitoring	- Continue immune support (Karbo Pellets / Epic Liquid) over 2-3 months. IVC Journal+1   - Maintain strong deworming program (every ~2 months in some protocols, rotating dewormers) to keep parasite load low. thewholehorse.com+1   - Good overall management: nutrition, minimal stress, pasture management, clean feed/hay storage to avoid contamination from opossum feces, etc. thewholehorse.com+1

Example timeline

Here is an example of how the timing might work in an aggressive case: IVC Journal+1

1. Day 0: Give Ivermectin if overdue. Start immune system support (e.g. Karbo Pellets + Epic Liquid).

2. After ~3 weeks: Begin Panacur PowerPak for 5 days (double dose).

3. Wait 10 days. Then Quest Plus at full weight.

4. Wait another ~10 days. Then regular Quest.

5. After last dewormer dose, wait ~5 days. Then start Sefacon (herbal) for 10 days (dosage scaled for size).

6. Continue immune support, nutritional improvements, and monitor improvement. If very severe, possibly a short course of conventional anti-protozoal (e.g. Marquis / ponazuril) to help rapidly reduce protozoa.

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Rationale / Why people do it this way

• The idea is that L4 (immature strongyle) larvae and other internal parasites weaken the immune system even if worm egg counts are low. These immature worms are NOT always detected with standard fecal egg counts but can still cause damage. So, aggressively targeting them helps the horse’s immune system recover. thewholehorse.com+1

  
  

• The immune system is central: stronger immune defenses reduce the chance protozoa get a “foothold” (or cause damage) and help the horse heal. Herbal and nutritional support is used to boost immunity, reduce inflammation, improve gut health.

• Herbal products (like Sefacon) are used as adjuncts to conventional dewormers / anti-protozoals, especially for somewhat slower clearance or maintenance phases.

  
  

Risks, caveats, things to consider

• Deworming aggressively, especially using potent or overlapping dewormers, carries risk of adverse effects (e.g. gut disturbance, colic, dewormer resistance, possible toxicity if overdosed).

• If a horse has severe neurological damage already, recovery may be slow or incomplete even with aggressive treatment.

• Some herbal dewormers or herbal remedies may have safety issues in pregnant mares, or may interfere with other treatments, or have variable potency.

• Need for veterinary supervision: testing (blood, possibly CSF), proper dosing, monitoring for side-effects, ensuring no other causes for neurological signs.

  
  

What is not part of the protocol, or less emphasized

• This “natural protocol” does not rely purely on herbal alternatives (many cases use conventional anti-protozoal drugs when needed).

• It's not just herbs; it’s more of a combined or integrative approach (parasite control, immune support, nutrition, herbal or pharmaceutical anti-protozoals).