Etiologies varied, with three due to identified genetic causes including pantothenate kinase asso-ciated neurodegeneration (PKAN), hypomyelinating leukodystrophy-14, CASK-related disorder, and a single case with undetermined, likely genetic etiology with normal im-aging and lack of other risk factors. Here, CASK is linked to pantothenate kinase-associated neurodegeneration.