Precision Ketogenic Therapy (PKT) is a dietary therapy to reduce seizures. Carbohydrates are reduced and the calories are replaced with fat. PKT is frequently used when other therapies for epilepsies such as medications have failed. PKT requires a very precise and personalized dietary prescription. It involves a significant amount of work on the part of the caregivers.
The positive effect of fasting on seizures has been documented for centuries in the writings of many cultures. In 1921, the ketogenic diet was first used medically to treat seizures. In the 1990s, the ketogenic diet for seizures had a resurgence of use in the clinical setting. Another use of a keto diet that has recently become popular is for weight loss and improvement of athletic performance.
If today there are several versions of the 1921 diet and of the weight loss diets that have been modified to treat seizures, then why was Precision Ketogenic Therapy created?
● Are PKT meals unpalatable, boring, and restrictive?
● Can patients be on PKT and get all the nutrients they need?
● Will patients lose weight because it is a keto diet or gain weight because of all the fat they eat?
● What happens when patients must go off therapy after 2-3 years?
● My adult patients would not benefit from the therapy, correct?
Patient acceptance of PKT meals is essential for the patient to stay compliant. Personalized cookbooks are a critical tool for patient success.
The correct PKT diet prescription is the key to having a thriving patient in good nutritional status. The incorrect PKT diet prescription could lead to nutrient deficiencies and accompanying symptoms that require stopping the diet after 2-3 years to recover.
Screening labs, fasting plasma amino acids, plasma acylcarnitine profile, and urinary organic acids, are obtained to confirm that a low carbohydrate and high-fat diet will not harm the patient before offering PKT to the patient.
The state of nutritional ketosis and the level of hydration are important to the success of PKT. Urine ketones are monitored daily to document nutritional ketosis. Although the use of equations to predict fluid requirements is helpful, the use of urine specific gravity is better. Fluid needs fluctuate in many patients, an elevated urine specific gravity is a practical indicator that the patient needs more fluid.
Since the nutrients used to treat seizures greatly influence the health of many organs; a complete metabolic panel, lipid panel, complete blood count with differential, phosphorus, magnesium, and uric acid are ordered regularly. In addition, beta-hydroxybutyrate concentration in plasma is monitored to document the level of ketosis.
Nutrients used to treat seizures must also support a healthy body composition. Regular monitoring of body measurements is used to document a patient’s health. Skinfolds and circumferences are easy to perform, inexpensive, noninvasive, and useful in estimating body composition. In adults, healthy weight and BMI must be maintained, and in children, a healthy growth rate.
A team effort is required by caregivers and healthcare providers to accurately document the intervention (nutrient intake) and the impact of the intervention (seizures and requirement for antiseizure medication) daily. The data should be used to modify PKT as the patient’s needs change.
Checklists prevent errors, assign responsibility for each task, and document who did what. We have provided some example checklists to help you create your own.
Standard Operating Procedures (SOPs) are a crucial step in the quality control of patient care. We have provided our PKT SOPs as samples to help you develop your own.
Templates are used for data collection, data documentation, and data wrangling. We are happy to share our PKT templates with you.
Education materials are needed by patients, families, healthcare colleagues, and PKT researchers to optimize PKT care. We all need to share what we have so that it can be improved.
