Our understanding of the syndromes of Neurodegeneration with Brain Iron Accumulation (NBIA) continues to
grow considerably. In addition to the core syndromes of pantothenate kinase-associated neurodegeneration (PKAN,
NBIA1) and PLA2G6-associated neurodegeneration (PLAN, NBIA2), several other genetic causes have been identified
(including FA2H, C19orf12, ATP13A2, CP and FTL). In parallel, the clinical and pathological spectrum has broadened
and new age-dependent presentations are being described. There is also growing recognition of overlap between the different
NBIA disorders and other diseases including spastic paraplegias, leukodystrophies and neuronal ceroid lipofuscinosis
which makes a diagnosis solely based on clinical findings challenging. Autopsy examination of genetically-confirmed
cases demonstrates Lewy bodies, neurofibrillary tangles, and other hallmarks of apparently distinct neurodegenerative
disorders such as Parkinson’s disease (PD) and Alzheimer’s disease. Until we disentangle the various NBIA genes and
their related pathways and move towards pathogenesis-targeted therapies, the treatment remains symptomatic.
Our aim here is to provide an overview of historical developments of research into iron metabolism and its relevance in
neurodegenerative disorders. We then focus on clinical features and investigational findings in NBIA and summarize
therapeutic results reviewing reports of iron chelation therapy and deep brain stimulation. We also discuss genetic and
molecular underpinnings of the NBIA syndromes.