Do you have a horse or know of one impacted by EPM? Equine Protozoal Myeloencephalitis (EPM) is unfortunately a common disease in the horse, impacting hundreds, if not thousands every year. The outcomes for each case can vary dramatically, resulting in a huge expenditure for the owner and an uncertain future for the horse. Give the huge variability in outcomes despite newer treatment options, one is left asking ‘why’ and what more can be done to aid in prevention and therapy to help increase the success rates. Maybe it is time to rethink our approach to these cases in order to maximize the outcome.