There are two forms of PKAN, classical and atypical.

Classic PKAN: Symptoms of classic PKAN develop during early childhood, usually before age 10, and usually include:

• Dystonia (sustained muscle contractions causing repetitive movements) and poor balance: The first symptom is often difficulty with movement and walking. Children are often first considered clumsy as their legs can be rigid, dystonic (an abnormality of muscle tone) and have involuntary muscle spasms (spasticity); these symptoms worsen over time and affect the arms. As affected individuals age, they may eventually lose control of voluntary movements. Muscle spasms combined with decreased bone mass can result in bone fractures. The disease may be stable for long periods of time and then undergo intervals of rapid deterioration, often lasting one to two months. Children usually lose the ability to walk by 10-15 years after the beginning of symptoms.
• Speech, chewing and swallowing problems: Many people may have speech problems and may also have enough trouble with chewing and swallowing that a feeding tube becomes necessary, due to dystonia affecting the muscles in the mouth and throat.
• Vision problems: Two-thirds of children with classical PKAN develop peripheral (side) vision loss and night blindness due to a degeneration of parts of the retina.
• Intellectual disability: Cognitive functioning varies from person to person and can range from high average to below average.

Atypical form: Features of the atypical form usually progress more slowly and appear within the first three decades of life. Signs and symptoms may include:

• Speech difficulty: Are usually the first symptoms, characterized by speech difficulty such repetition of words or phrases (palilalia), rapid speech (tachylalia), and poor articulation/slurring (dysarthria).
• Psychiatric symptoms such as behavioral problems, personality changes, violent outburst, and depression are more commonly observed.
• Movement problems: While movement problems are a common feature, it usually develops later than the classic form. Loss of independent walking often occurs 15-40 years after the initial development of symptoms.
• Vision problems: Retinal degeneration is rare in the atypical form.

All individuals with PKAN have an abnormal buildup of iron in certain areas of the brain. A particular change, called the eye-of-the-tiger sign, which indicates an accumulation of iron, is typically seen on magnetic resonance imaging (MRI) scans of the brain in people with this disorder.

• Medication: The tremors best respond to dopaminergic agents. Benzodiazepines are used to improve muscular contraction and twisting and writhing movements. Dystonia is treated with oral trihexyphenidyl, oral baclofen or a baclofen pump, and oral clonazepam. Intramuscular botulinum toxin is used for muscle spasms, especially in treating a limited body region (injections in the facial muscles can greatly improve speech and eating abilities). Methscopolamine bromide can be used for excessive drooling.
• Surgical procedures: Procedures to destroy specific parts of the brain, the pallidus (ablative pallidotomy) or the thalamus (thalmotomy) may provide temporary relief for dystonia.
• Deep brain stimulation: A procedure where a medical device called a brain pacemaker is implanted to send electric impulses to specific parts of the brain for the treatment of movement and mood disorders.
• Services for the blind and educational programs.
• Physical therapy and occupational therapy to maintain normal joint mobility
• Adaptive aids (walker, wheelchair) for gait abnormalities.
• Speech therapy and/or communication devices.