Deactivation of the left dorsolateral prefrontal cortex in Prader-Willi syndrome after meal consumption

BACKGROUND/OBJECTIVES: Prader-Willi syndrome (PWS) a type of human genetic obesity may inform us about the physiology of non-syndromic obesity. Objective of this study was to investigate the functional correlates of hunger and satiety in individuals with PWS in comparison to healthy controls with obesity, hypothesizing that we would see significant differences in activation in the left dorsolateral prefrontal cortex (DLPFC) based on prior findings. SUBJECTS/METHODS: This study compared the central effects of food consumption in 9 individuals with PWS (7 men, 2 women; body fat 35.3%±10.0) and 7 controls (7 men; body fat 28.8%±7.6), matched for percentage body fat. H(2)(15)O PET scans were performed before and after consumption of a standardized liquid meal to obtain quantitative measures of regional cerebral blood flow (rCBF), a marker of neuronal activity. RESULTS: Compared with obese controls, PWS showed altered (p<0.05 FWE cluster-level corrected; voxelwise p<0.001) rCBF before and after meal consumption in multiple brain regions. There was a significant differential rCBF response within the left DLPFC after meal ingestion with decreases in DLPFC rCBF in PWS; in controls DLPFC rCBF tended to remain unchanged. In more liberal analyses (voxelwise p<0.005) rCBF of the right orbitofrontal cortex (OFC) increased in PWS and decreased in controls. In PWS, ΔrCBF of the right OFC was associated with changes in appetite ratings. CONCLUSION: The pathophysiology of eating behavior in PWS is characterized by a paradoxical meal induced deactivation of the left DLPFC and activation in the right OFC, brain regions implicated in the central regulation of eating behavior.