I agree with Cheryl.

Attacks, progression, certain meds (or lack of meds), triggers, lack of exercise/overall health, diet, stress level, heat . . . all sorts of things can impact fatigue and spasticity.

Sometimes symptoms which are eventually deemed "permanent" can improve too, whether that be by chance, by making changes in our lifestyle, or by using (or losing) certain drugs. I had bad spasticity for two years, and it was deemed permanent (without the use of neurontin, or whatever might help). LDN took away that symptom, and dropping antidepressants helped my fatigue level, tennitus, etc.

A lot is trial and error.

Cherie