A remarkable and unique case of multiple hits was observed in a patient who accumulated four hits: the originally detected ITPR1 deletion and three potentially deleterious non-synonymous SNVs in RYR2, HOMER2 and STARD13. RYR2 (ryanodine receptor 2) and ITPR1 (inositol-1,4,5-trisphosphate receptor 1) have been independently reported to be implicated in brain disorders. This evidence concerns the gene ITPR1 and brain disorder.