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An exploratory retrospective analysis of concurrent metabolic and behavioral change in Prader-Willi syndrome during
Geethanjali Ravindranathan1, Blythe Stockton1, June Finnerty1
1Nexus Health Systems, Nexus Corporate Office, Houston, TX, United States.
Background:
Prader-Willi syndrome (PWS) is a rare neurodevelopmental disorder with hyperphagia, hypothalamic dysfunction, and severe behavioral dysregulation. Empirical descriptions of integrated inpatient treatment models remain limited. We examined multidomain outcomes during interdisciplinary inpatient stabilization in PWS.
Methods:
This exploratory retrospective cohort included nine adolescents and young adults with genetically confirmed PWS admitted for severe behavioral dysregulation to a specialized interdisciplinary inpatient program. Behavioral, functional, anthropometric, and fasting metabolic outcomes were assessed at admission and discharge; medication profiles were recorded descriptively and three-month follow-up obtained via caregiver interview. Within-subject change was analyzed with Wilcoxon signed-rank tests.
Results:
Token engagement increased (median 8 percentage points, p < 0.05) and aggression resolved: every patient had incidents in the first week, none in the final week (p = 0.004). Agitation showed a non-significant decrease (p = 0.063, floor effect) and global behavioral disturbance was non-significant (p = 0.24). Walk distance and functional independence improved (both p < 0.05). Weight decreased 73 lbs (1.2% per week) and BMI by 11.9 kg/m2 (both p < 0.05), with improvements in triglycerides, HbA1c, HDL, LDL, and total cholesterol (all p < 0.05). No behavioral-metabolic correlations survived false discovery rate adjustment. At three months, 89% remained in the community without rehospitalization and 77% rated global well-being as good or excellent.
Conclusions:
Structured interdisciplinary inpatient treatment for severe behavioral dysregulation in PWS was associated with multidomain improvement across behavioral, functional, and cardiometabolic domains. Behavioral and metabolic changes were not directly coupled; causality cannot be inferred. These findings support prospective investigation of integrated treatment models.