Extrapyramidal symptom brain metabolism

The neuroleptics show variable absorption after oral administration. These agents readily pass into the brain, have a large volume of distribution, bind well to plasma proteins, and are metabolized to many different substances by the P-450 system in the liver. Fluphenazine decanoate and haloperidol decanoate are slow release (up to 3 weeks) formulations of neuroleptics, administered by intramuscular injection. These drugs are increasingly used in treating outpatients and individuals who are noncompliant. However, about 30% of these patients develop extrapyramidal symptoms. The neuroleptic drugs produce some tolerance but little physical dependence. 

In addition to the direct toxic effects of copper, in certain brain areas, as in the pineal gland, ATP7B is expressed and functionally active (Boijigin et al., 1999). Glucose metabolism, especially in striatal and cerebellar areas, is disturbed in patients with WD and correlates with the severity of extrapyramidal motor symptoms. The most severe cases are characterized by the lowest consumption in the striatal area. When there is marked improvement of extrapyramidal motor symptoms impaired glucose consumption reveals a persistent brain lesion (Hermann et al., 2002). 

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