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I have had generalized myasthenia gravis for just over three years. The medication I take is mestinon, three times a day. With medication, I no longer have double vision from my left eye, facial drooping or swallowing issues but I do have muscle weakness in the buttocks and upper leg muscles which increases as the day goes on. My very first symptom was double vision which I believe was seriously aggravated by taking magnesium as a supplement. So I would caution others taking this supplement. I also avoid cereals that contain magnesium.
I am in physical therapy for lower back pain and the treatment plan is to strengthen my core muscles. Why? If the core muscles are stronger than those muscles tighten the muscles surrounding the spine and consequently less pain emanating from the spine. They hold the spine in place. If the buttocks muscles and upper leg muscles are weakened by MG then the spine can cause pain if the spine already has arthritis, stenosis etc. That is what happened in my case. With a weakened core I do experience lower back pain when I get up in the morning but it soon dissipates after I walk for a minute but again a stronger core helps. Sleep helps restore muscles so taking mestinon before going to bed does not make sense to me and if I feel stronger I will delay my first dose until mid-morning or later. It is only as the day progresses and the muscles weaken that I do experience wobbliness when walking. Best, Paul D