Take control of Saria, who must travel through nine worlds in the land of Alpherion to rescue wizards in each one and recover gemstones from Gadou an evil villain. The game features a top-down view and Saria must shoot everything that moves with one of her three selectable weapons. Special power-ups allow for screen-clearing devestation, but only three can be carried at any time. Maps vary both in length and complexity, from linear to maze like ones with multiple paths to reach the end. Every level ends with a boss.

Since the game was only released in Japan, no offical English translation exist, there are however fan translations available. Twinkle Tale is also one of the rarest Sega Megadrive games, fetching high prices in the used marked.