Pyridostigmine was my first medication, which caused a bad rash on my legs so I had to stop taking it, but it was fairly fast acting, took about 2-3 hours for double vision to go away. After that Prednisone, for 2 months, my primary care (pre neurology) had me on 5mg a day, which after 6 weeks, double vision was back. Neurologist bumped me to 20..25..30..35, at 25 double vision went away. I'm still working my way up, trying to get chewing issues under control. The main downside for me with prednisone is insomnia. I can sleep and do sleep, but if something wakes me up at say 4:30am that is it, I am up for the day. I'm also taking a lot of vit D, K2, calcium to counter prednisone bone issues. Eventually i'm going to switch to something else, but my Neurologist wants me to stabilize before trying something new, change one thing at a time.