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All eight patients with positive anti-Ryanodine antibodies were treated with pyridostigmine,and these patients showed significant improvements in mRS scores (Wilcoxon Z = -4.066, p = 0.003) Conclusion: Ryanodine receptor-positive myasthenia may be a potential cause of post-stroke fatigue (PSF) and should be considered in clinical situations where acetylcholine receptor (AcHR) antibodies are negative