has material basis in germline mutation in LDB3 congenital nervous system disorder myofibrillar myopathy 4 https://www.malacards.org/card/myopathy_myofibrillar_4 Late-onset distal myopathy, Markesbery-Griggs type is a rare, genetic, non-dystrophic myofibrillar myopathy disorder characterized by late-adult onset of distal and/or proximal limb muscle weakness with initial involvement of posterior lower leg muscles, medial gastrocnemius and soleus. Patients present with ankle weakness followed by weakness of finger and wrist extensors and later on of proximal muscles. Ambulation is usually preserved. Late-onset associated cardiomyopathy and/or neuropathy has been reported in a minority of cases. OMIM:609452 LDB3 myofibrillar myopathy (disease) MFM4 myofibrillar myopathy (disease) caused by mutation in LDB3 ZASP-related myofibrillar myopathy late-onset distal myopathy, Markesbery-Griggs type MONDO:0012277 myopathy, myofibrillar, 4 DOID:0080095 MEDGEN:1648314 Orphanet:98912 GARD:0001886 myopathy, myofibrillar, type 4 MESH:C563718 UMLS:C4721886 myofibrillar myopathy type 4 autosomal dominant distal myopathy qualitative or quantitative defects of protein ZASP myofibrillar myopathy