Authors :
Presenting Author: Steven Winesett, MD – University of Florida
Peggy Borum, PhD – Professor, Nutrition, University of Florida; Edgard Andrade, MD – Associate Professor, Pediatrics, University of Florida; Maria Bruzzone Giraldez, MD – Assistant Professor, Neurology, University of Florida; Jean Cibula, MD – Associate Professor, Neurology, University of Florida
Rationale:
Modifications to the classical ketogenic diet have been reported since the 1990’s resurgence in its use to treat epilepsy. Patients frequently began therapy in poor nutritional status, therapy was often stopped after two to three years to give patients a “break” from the therapy and there was little opportunity for adult patients to attend a keto clinic. Our Precision Ketogenic Therapy (PKT) Program took a precision medicine approach to address these issues by modifying the classical ketogenic diet through both precision and personalization of the therapy.
Methods:
We established a Pediatric PKT Clinic and an Adult PKT Clinic designed to allow PKT initiation of all ages and to allow a seamless transition from one clinic to another as the person matures. We created a Foodomics database using data collected yearly from the Nutrition Facts Labels of foods available for purchase in local markets. We developed a PKT diet prescription approach that addresses the nutritional needs and preferences of the patient and then induces nutritional ketosis using a keto ratio (fat grams/protein grams + carb grams) ranging from 1.5:1 to 5.0:1. All food is weighed to the nearest tenth of a gram and total carbohydrate is used in calculations with interest in the importance of fiber. To administer the PKT diet prescription, each patient receives a personalized PKT cookbook with recipes that provide current nutritional needs, address any special feeding requirements, meet food preferences of the patient and family, and accommodate financial or food accessibility issues. Tools have been developed to monitor therapy efficacy and tolerance including nutritional and metabolic status.
Results:
Our Pediatric PKT Clinic and Adult PKT Clinic allow us to initiate and care for all ages and improve the transition process of pediatric patients to adult care as they age up. Each of our PKT tools and protocols are designed to maintain precision and personalization for a wide range of ages and diagnoses. PKT is administered not as an adjunct to epilepsy care, but as an integral part of that particular patient’s epilepsy care that adapts as the patient changes. The approach has resulted in long-term care for very diverse patients without the metabolic complications sometimes experienced by keto patients. For example, in 2023 we have 16 patients who have been on PKT for more than five years, eight patients who have been on PKT for more than 15 years, and four patients that have been on PKT for more than 20 years.
Conclusions:
PKT permits induced nutritional ketosis for long-term care for all ages of epilepsy patients with a wide variety of etiologies/syndromes. In addition to seizure improvement, we hear frequent reports of improved quality of life for the patient and the rest of the family in spite of the continuing extra effort to make keto meals. Additional information may be found at
https://borum.ifas.ufl.edu/.
Funding:
University of Florida Clinical and Translational Science Institute supported in part by the NIH National Center for Advancing Translational Sciences under award number UL1TR001427.