Hello dear forum friends. I’m a newbie here and learning a lot from you all. I am AChR positive, bulbar presentation with lost voice and swallowing issues. Did 5 plasmapheresis sessions, no improvement. Did also the first 2 sessions of Rituximab (14 days apart, last one done 10 days ago), and I feel my symptoms are worsening. I am now on mestinon 60 mg 3 /day plus prednisone 20 mg. Has anyone experienced their fingers shaking? Any muscles twitches? I have twitches all over my body and my fingers and my toes sometimes move on their own… thank you for any sharing.