Weak myasthenic muscles were tested by nerve stimulation both at normal temperature and after local cooling that was accomplished by exposing the skin to ice bags or cold paraffin oil. Reduction of intramuscular temperature from 35 C to 28 C increased the voltage of the bellytendon electrical response, the force of the isometric twitch, and the force of the tetanus elicited by 10/sec or 20/sec nerve stimulation. The myasthenic decrement of successive muscle responses was less marked after cooling, as were "delayed rundown" and "postactivation exhaustion." All these effects were reversed on rewarming the muscle. The abnormal neuromuscular jitter in motorunit components was also reduced by local cooling. These observations may explain why diagnostic application of repetitive stimulation may be false-negative; muscle temperature must be controlled.
Borenstein S, Desmedt JE. Local Cooling in MyastheniaImprovement of Neuromuscular Failure. Arch Neurol. 1975;32(3):152–157. doi:10.1001/archneur.1975.00490450032003