Originally Posted by alice md

There is a possible physiological explanation for why it happens ( in some patients, probably more in MuSk and seronegative), but doesn't really matter.
That is why I try to take longer acting medications which do not have such extremes in their levels. And also recognize very early signs of weakness, so that I stop before I crash. (doesn't always work even now when I am highly "experienced").

But, this has been a very long learning experience. Almost like finding out what tigers like to eat in the hundred acre woods. I too do very well with cough syrup my neurologist prescribed for me!