Effect of local cooling on excitation-contraction coupling in myasthenic muscle: Another mechanism of ice-pack test in myasthenia gravis.

•We evaluated the effects of local cooling on muscle twitch in myasthenia gravis.•Local cooling induced amelioration of impaired excitation-contraction coupling in ice-pack-positive myasthenia gravis.•The ice-pack test induces effects on synaptic transmission and excitation-contraction coupling.