My symptoms are episodic also. Usually if I do too much I will get more MG symptoms in my legs and throat. Other times I can do strenuous exercise with no MG and still other times I can do relatively nothing and get hammered with the MG. I take low doses of mestinon, 30mg every 4 - 5 hours, and take slightly more when I need it. Over the past two years this seems what works best for me. 60mg at any one time makes me sick unless the symptoms are severe. You need to find out what you body tolerates the best. If you can stay away from the stronger meds and live with the disease it would probably be the best as all the meds except Mestinon have side affects. At least that is my plan. I was on Prednisone for 4 months and just came off and am finally starting to get back to normal. As it did help with the disease the side affects for me were terrible.

Hope you can figure out what is best for you.
Al