Neurodegeneration with brain iron accumulation (NBIA)

Symptoms of NBIA begin in childhood or adulthood.

There are 10 types of NBIA. Each type is caused by a different gene variant. The most common gene variant causes the disorder called PKAN (pantothenate kinase-associated neurodegeneration).

People with all forms of NBIA have a buildup of iron in an area deep inside the brain called the basal ganglia as well as other areas of the brain that help regulate movements.

NBIA mainly causes movement problems. Other symptoms may include:

• Dementia
• Difficulty speaking
• Difficulty swallowing
• Muscle problems such as rigidity or involuntary muscle contractions (dystonia)
• Seizures
• Tremor
• Vision loss, such as from retinitis pigmentosa
• Weakness
• Writhing movements
• Toe walking

Your health care provider will perform a physical exam and ask about symptoms and medical history.

Genetic tests can look for the variant gene that causes the disease. However, these tests aren't widely available.

Tests such as an MRI scan can help check for other movement disorders and diseases. The MRI usually shows iron deposits in the basal ganglia, and are called the "eye of the tiger" sign because of the way the deposits look in the scan. This sign suggests a diagnosis of PKAN.

There is no specific treatment for NBIA. Treatment is mainly focused on regulating the symptoms. The most commonly used medicines to regulate symptoms include baclofen and trihexyphenidyl.

NBIA damages the nerves over time and symptoms get worse. It leads to a lack of movement, and often death by early adulthood.

Medicine used to treat symptoms can cause complications. Being unable to move due to the disease can lead to:

• Blood clots
• Respiratory infections
• Skin breakdown

Contact your provider if your child develops:

• Increased stiffness in the arms or legs
• Increasing problems at school
• Unusual movements

Genetic counseling may be recommended for families affected by this illness. There is no known way to prevent it.

Hallervorden-Spatz disease; Pantothenate kinase-associated neurodegeneration; PKAN; NBIA

Jankovic J. Parkinson disease and other movement disorders. In: Jankovic J, Mazziotta JC, Pomeroy SL, Newman NJ, eds. Bradley and Daroff's Neurology in Clinical Practice. 8th ed. Philadelphia, PA: Elsevier; 2022:chap 96.

NBIA Disorders Association website. Overview of NBIA disorders. www.nbiadisorders.org/about-nbia/overview-of-nbia-disorders. Accessed August 20, 2024.

Updated by: Joseph V. Campellone, MD, Department of Neurology, Cooper Medical School at Rowan University, Camden, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.