By the time she was 10, Megan Lee Hardgrave's trancelike epileptic seizures, which she called "the stares," were gaining strength. She would watch her parents' faces darken into purple or blue blobs, or freeze while gazing at the blackboard in school or get lost inside her family's church.
Powerful medicines left the Carrollton, Texas, girl sick and emaciated. But even an arsenal of drugs failed to halt the seizures, which struck as often as once an hour. In November 1988, she came to Johns Hopkins Hospital in Baltimore for tests to determine whether a risky operation to remove half of her brain would help.
Doctors decided it would not. So they offered her parents an alternative, a weird diet loaded with fatty foods such as mayonnaise, butter and bacon -- the ketogenic diet.
The Hardgraves were baffled.
"We came up here for brain surgery, and you suggest a diet? Are you serious?" said David Hardgrave, a manager with a Dallas engineering firm.
Doctors have used the ketogenic diet to treat seizures, essentially fierce electrical gales in the brain, for more than 70 years. But its use has declined over the past half-century with the development of modern drugs and surgical techniques. Many neurologists now regard it as a relic of a less sophisticated age -- difficult to follow, often ineffective and, at best, a last resort.
Hopkins, though, retains a stubborn faith in the diet, using it to treat 15 to 20 children a year with what doctors there say is remarkable success.
Dr. John M. Freeman, director of the pediatric epilepsy unit at Hopkins' Children Center, and several of his colleagues last year published a study showing the diet stopped or significantly reduced seizures in more than two-thirds of their patients.
The study, though, was a review of past cases and not the type of controlled trial researchers consider the best test of a treatment.
Other doctors, Hopkins neurologists say, should be more willing to prescribe the diet because it carries neither the mind-fogging side effects of many medicines nor the perils of surgery.
Four years ago, when Dr. Freeman and Dr. Eileen P. G. Vining recommended the diet to Megan's parents, they warned that it required a lot of work, will power and a two-year commitment.
The diet permits only a sprinkling of protein and carbohydrates. Sugar and starch, including staples such as bread and potatoes, are forbidden. Each portion of every meal must be planned in advance and weighed to the gram.
