The game follows the adventures of a young vampire, the title character Spike McFang, who is set to battle with the evil zombie general Von Hessler, who attempts to invade his parents' and his friend Camelia's kingdoms. The game plays from a top-down perspective; the player encounters several enemies in the game and by defeating them, can gain experience points and increase his level. Spike's main weapons are his cape, that attacks in a short range (though Spike can extend its range at the risk of dizzying himself for a short time) and his hat, which can be thrown like a boomerang. He is also able to utilize magical cards with a wide variety of special effects, including, but not limited to:

• Invisibility
• Summoning angels and bats
• Turning all foes into small, furry animals
• Grabbing a balloon and floating to safety.
• Elemental Attacks
• Powered up partner
• Recovering Health

The American release of The Twisted Tales of Spike McFang was slightly altered. The enemies have higher defense and after Spike gains a level, his health doesn't get replenished. As a result, the game was more challenging than its Japanese counterpart. The shopkeeper, Dowson, was originally a pretty blonde girl. In the American version, this was changed to a mummified creature. Additionally, the health power-ups were hearts in the original Japanese version, but became tomatoes in the American version.