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Prader-Willi syndrome

Also known as: Prader-Willi Labhart

Background

Prader-Willi syndrome is characterised by two main phases. At birth and in infancy, hypotonia (floppiness), sleepiness and feeding difficulties are usually present. Thereafter, hypotonia lessens, feeding difficulties stop and hyperphagia (over eating) begins, usually between the ages of two to four years.

Credits

Last updated October 2017 by Dr J Whittington, Senior Research Associate, Section of Developmental Psychiatry, Department of Psychiatry, University of Cambridge, Cambridge, UK.

Although great care has been taken in the compilation and preparation of all entries to ensure accuracy, we cannot accept responsibility for any errors or omissions. Any medical information is provided is for education/information purposes and is not designed to replace medical advice by a qualified medical professional.

What are the symptoms?

  • Severe hypotonia at birth
  • Feeding difficulties at first
  • Hypogonadism (undescended testicles in males, reduced or lacking menstruation in females)
  • Mild to moderate intellectual disabilities (see entry Learning Disability)
  • Obesity (in the absence of food restrictions this appears to be universal).

The syndrome often includes:

  • short stature
  • developmental delay in walking and speech
  • obsessive behaviour
  • strabismus (squint)
  • small hands and feet
  • skin picking
  • scoliosis
  • diabetes (see entry Diabetes Mellitus)
  • challenging behaviour
  • psychiatric illnesses (usually starting in late adolescence and adulthood).

The two main genetic subtypes (deletion and maternal disomy; see 'What are the causes') differ in many respects, including: average maternal age at birth, 'fair for family' pigmentation, cognitive strengths and weaknesses, and risk of depressive (greater in deletion subtype) and psychotic (greater in maternal disomy subtype) illnesses.

The above characteristics, although typical of people with Prader-Willi syndrome in general, do not all apply to everyone with the syndrome.

What are the causes?

Prader-Willi syndrome is very rarely inherited.  It occurs sporadically due to the loss of expression of maternally silenced genes on the chromosome 15 of paternal origin. Historically,  approximately 70% of cases are due to a deletion, (missing segment), and in most other cases both copies of chromosome 15 are maternal in origin (maternal disomy) with no paternal copy. Genetic testing is undertaken using DNA and parental blood samples may be requested to confirm maternal disomy.

How is it diagnosed?

The condition is suspected if a baby has severe hypotonia, and if there is reduced foetal movement, breech presentation or other complications of pregnancy. Genetic testing is needed to confirm the diagnosis. Genetic testing is routine in known risk carriers.

How is it treated?

There is no cure for PWS. Dietary management is the cornerstone of managing the associated obesity. Typically, carers have to limit access to food and take over total control of food intake. Behaviour modification methods which rely on reinforcement and self-monitoring as part of weight control and exercise programmes are also required, though long-term maintenance of weight loss is difficult to achieve. Behaviour management is key in controlling the outbursts of rage and aggression, stubbornness and belligerence, which are common in affected individuals, beginning around age three to five and becoming more marked later in childhood and persisting into adulthood. Growth hormone supplements are also used to increase final stature and improve body composition and activity levels.

Inheritance patterns and prenatal diagnosis

Inheritance patterns

People with PWS are usually infertile. If a male with deletion PWS fathers a child, it will have a 50% chance of inheriting PWS (no cases documented). If a female with deletion PWS gives birth, the child will have a 50% chance of being born with Angelman syndrome (one case documented). If a male with maternal disomy or imprinting centre defect fathers a child it will be normal if the imprint resets, otherwise it will be disomy. If a female with maternal disomy or imprinting centre defect gives birth, the child will be normal (one case documented). 

Prenatal diagnosis

Usually none at present. There may be reduced foetal movement. In the very rare known carrier families, amniocentesis may be recommended.

Is there support?

Prader-Willi Syndrome Association UK

Helpline: 01332 365 676
Email: admin@pwsa.co.uk
www.pwsa.co.uk

The Association is a Registered Charity in England and Wales No. 1155846. It provides information and support to anyone affected by Prader-Willi syndrome (PWS). The Association offers family days and weekends, regional events, peer to peer support and training. 

Group details last updated October 2017.

Talk to other families about your child's condition

Visit our online Prader-Willi syndrome group

Visit our online advice and support or read all about diagnosis.


You can also call us if you need information or advice on any aspect of caring for a disabled child. Monday to Friday, 9.30am to 5pm.


0808 808 3555 or helpline@contact.org.uk