Syndromes of neurodegeneration with brain iron accumulation (NBIA): an update on clinical presentations, histological and genetic underpinnings, and treatment considerations

Mov Disord. 2012 Jan;27(1):42-53. doi: 10.1002/mds.23971. Epub 2011 Oct 26.


In recent years, understanding of the syndromes of neurodegeneration with brain iron accumulation (NBIA) has grown considerably. In addition to the core syndromes of pantothenate kinsase-associated neurodegeneration (PKAN, NBIA1) and PLA2G6-associated neurodegeneration (PLAN, NBIA2), several other genetic causes have been identified. The acknowledged clinical spectrum has broadened, age-dependent presentations have been recognized, and we are becoming aware of overlap between the different NBIA disorders as well as with other diseases. Autopsy examination of genetically confirmed cases has demonstrated Lewy bodies and/or tangles in some subforms, bridging the gap to more common neurodegenerative disorders such as Parkinson's disease. NBIA genes map into related pathways, the understanding of which is important as we move toward mechanistic therapies. Our aim in this review is to provide an overview of not only the historical developments, clinical features, investigational findings, and therapeutic results but also the genetic and molecular underpinnings of the NBIA syndromes.

Publication types

  • Historical Article
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Brain / metabolism
  • Ceramides / metabolism
  • Ceruloplasmin / deficiency
  • Group VI Phospholipases A2 / genetics*
  • History, 19th Century
  • History, 20th Century
  • Humans
  • Iron / metabolism
  • Iron Metabolism Disorders
  • Lewy Bodies / pathology
  • Neuroaxonal Dystrophies
  • Neurodegenerative Diseases
  • Pantothenate Kinase-Associated Neurodegeneration / genetics*
  • Pantothenate Kinase-Associated Neurodegeneration / history
  • Pantothenate Kinase-Associated Neurodegeneration / metabolism
  • Pantothenate Kinase-Associated Neurodegeneration / pathology*
  • Phosphotransferases (Alcohol Group Acceptor) / classification
  • Phosphotransferases (Alcohol Group Acceptor) / genetics*


  • Ceramides
  • Iron
  • Ceruloplasmin
  • Phosphotransferases (Alcohol Group Acceptor)
  • pantothenate kinase
  • Group VI Phospholipases A2
  • PLA2G6 protein, human

Supplementary concepts

  • Familial apoceruloplasmin deficiency
  • Neuroferritinopathy