Odd...

I'd ask your neuro to look at a mestinon alternative:
Physostigmine
Neostigmine
Pyridostigmine - this is Mestinon
Ambenonium
Demarcarium
Rivastigmine

Mestinon does the job better than any other Cholinesterase Inhibitors but there are alternatives if you can't use it. All of the above are reversible so they would behave in a similar manner to Mestinon and have a relatively short half-life in your system. I would think that you would need *something* to manage the downs if you're experiencing a lot of ups & downs.

The imunosuppressant is great for long term reduction of the symptoms but on a daily basis I'd certainly want something to get over the hump on a bad one...