DYSF and protein S deficiency: Clinical diagnosis mostly relies on laboratory ancillary tests and genetic testing, including serological markers of myocyte membrane disruption, CK (significant 35- to 200-fold increase in CK in blood); electromyography suggesting myogenic changes; pathological examination suggesting typical myotonic manifestations, inflammatory response, and myocyte membrane dysferlin protein deficiency (Fanin and Angelini, 2016).