Like Mega Microgames!, WarioWare - Twisted features an increasingly difficult series of microgames that players rotate the handheld system to complete. Most microgames last for just four seconds, but the Twisted series has many longer ones. The game also features short descriptions and four lives. The game can be played with two or four players at a time, which means that there are many ways to complete a game.
The game is a collection of minigames and has a huge variety of novelty items to collect. Some of the toys are unlockable after beating a boss game. After beating a boss, the player can spin a bonus prize to collect a light wand or other items. WarioWare - Twisted! was released in Japan in 2004 and was subsequently shipped to North America and Australia. It was not released in Europe, however. Critics generally liked the game, and its innovative use of motion sensing and buttons made it a hit.
Despite its similarities to its Japanese counterpart, WarioWare - Twisted! differs from its English-language release in several ways. There are minor graphical changes, but some notable changes have been made to the game's story, microgames, and souvenirs. One notable change is the replacement of the Mona Lisa with a new woman named Mona. Additionally, the game's logo includes a "wario wart" logo on the Game Boy Advance's roof, and the Mona Lisa is now in a spoof of the famous painting.