i went with only ocular symptoms for nearly 2 years. other sypmtoms presented during a bad case of the flu. i understand this is common. began with diffculty chewing, biting and swallowing. difficulty lifting above the shoulder. difficulty holding my head up for extended periods. the swallowing really became a problem. i lost 15 lbs. in 2 weeks. another dead giveaway is your voice goes nasal after only a few minutes talking. all this is controlled with mestinon now.