Emptying the fridge syndrome: a case of nocturnal food craving associated with peak perampanel concentration

Abstract

Perampanel, a non-competitive AMPA receptor antagonist, is widely used in treating focal and generalised epilepsy. We report the case of a 26-year-old man with pharmaco-resistant focal epilepsy who developed nocturnal compulsive food-seeking behaviour after off-label titration of perampanel to 24 mg/day. Symptoms resolved entirely after dose reduction, supporting a possible causal relationship. Pharmacokinetic data showed a 26 % increase in serum levels between near-trough and peak, potentially explaining the timing of nocturnal symptoms. This case underscores the importance of recognising atypical behavioural adverse events. Direct questioning is essential, as individuals may not spontaneously report such symptoms due to stigma or fear of losing seizure control.