Neuromuscular Diseases Division

The Neuromuscular Division is directed by David Lacomis, MD.  Dr. Lacomis and division members, Paula Clemens, MD, Sasa Zivkovic, MD, PhD, and Tawfiq Al-Lahham, MD provide care for neuromuscular patients including those seen in the affiliated Muscular Dystrophy Association Clinic and MDA-ALS Center (UPMC-Presbyterian campus).  Dr. Clemens also treats patients at the Pittsburgh VA Medical Center in Oakland including a multidisciplinary clinic for veterans with ALS. Drs. Zivkovic and Al-Lahham also treat patients at UPMC-Shadyside.

The division trains fellows in clinical neurophysiology and provides electrodiagnostic services (electromyography and autonomic testing) at UPMC-Presbyterian and UPMC-Shadyside. Dr. Lacomis performs needle muscle biopsies and is in charge of the neuromuscular pathology services in the Neuropathology Division. Dr. Clemens works with trainees through her research program and oversees the neurology residency training program at the VA Pittsburgh Healthcare System as Neurology Division Chief there.  

Dr. Clemens conducts an active research program with an emphasis on human clinical research for drug development and clinical trial readiness for muscular dystrophies. She is a study chair for a multi-site clinical trial program testing a first-in-class steroid for treatment of patients with Duchenne muscular dystrophy and Becker muscular dystrophy. She was study chair for an exon 53 skipping drug clinical trial that provided the privotal data resulting in drug approval by FDA and PMDA using the accelerated approval pathway. She continues as an advisor to the Phase 3 study for exon 53 skipping and testing skipping of additional exons. Furthermore, she is involved in human clinical research testing enzyme replacement therapy, chaperone small molecule therapy and adeno-associated viral vector-delivered gene replacement therapy for patients with late onset Pompe disease. In an academic, research leadership role, Dr. Clemens is the elected Medical Director of a multi-center academic trials group, the Cooperative International Neuromuscular Research Group (CINRG) devoted to natural history studies and treatment trials for Duchenne muscular dystrophy (DMD) and other forms of muscular dystrophy. Dr. Clemens is also contributing Pompe disease patient information to the Lysosomal Storage Diseases registry at UPMC (Dr. David Finegold, PI) and as a member of the North American Pompe Registry Board of Advisors for Sanofi/Genzyme. Dr. Clemens directs the University of Pittsburgh NeuroNEXT clinical study site (funded by NINDS). Dr. Clemens pursues pre-clinical, translational research in collaboration with Dr. Dana Ascherman (Rheumatology), studying an animal model of inflammatory myopathy. 

Another major area of research involves ALS. Under the direction of Dr. Lacomis, there are active multicenter studies of (1) serial blood, spinal fluid and electrodiagnostic biomarkers, (2) DNA banking and gene discovery and genomic translation for ALS care, and (3) effects of levosimendan on respiratory function. Dr. Lacomis provides subjects and tissues for induced skin pluripotent stem cell research (with Drs. Carlisle, Friedlander, and Donnelly) and also serves as the Director of Clinical Research in the Live Like Lou Center for ALS Research in the University of Pittsburgh Brain Institute. He works in close collaboration with Dr. Christopher Donnelly. They are also working with colleagues at the School of Public Health on environmental and genetic risk factors for ALS. The expanding Center is dedicated to all types of ALS research and Neurotechnology development including brain computer interface leading to improved quality of life for patients. 

Dr. Lacomis collaborates with colleagues in Rheumatology (Oddis and Aggarwal) on research studies in myositis. Last, Dr. Lacomis is an Associate Editor for the Journal of Clinical Neuromuscular Disease.

Dr. Zivkovic participated with Dr Soman in establishing an Amyloidosis working group at UPMC that led to establishment of University of Pittsburgh Cardiac Amyloidosis Center. He continues to perform clinical research on amyloid neuropathies and will serve as a site-investigator for clinical study investigating new treatment for TTR amyloid neuropathy with conjugated antisense oligonucleotides sponsored by Ionis Pharmaceuticals. He is a member of IGOS GBS Electrodiagnosis Expertise Group and CSF group and collaborates with Drs Jacobs, Harbo and Stino on a study of cerebrospinal fluid testing results in Guillain Barre syndrome. He is also a member of Brighton Collaboration working group on immunization-associated events, including vasculitis and vasculitic neuropathy. Dr Zivkovic also serves on AANEM Quality Improvement Committee and AAN Subspecialty Quality Advisors Group and participated in formulation of AANEM quality measures for diagnosing carpal tunnel syndrome.

Dr. Al-Lahham joined the Neuromuscular Disease Division in 2020, serving as the director of the MDA-ALS Center. He is working with Dr. Lacomis on expanding the ALS Center to provide accessible comprehensive care to ALS patients in Western Pennsylvania.  Our multidisciplinary clinic is in the final steps to become an ALSA Certified Treatment Center of Excellence by 2021.  With the steady growth in our Center we are aiming to join the Healey ALS Platform Trials.  Platform trials will test multiple interventions and accelerate the path to effective treatments for ALS.

Research activities for 2019-20 include an NIH-funded early feasibility study of Stentrode brain computer interface for augmentative communication, participation in studies on oral edaravone, and a new DNA banking project. Dr. Clemens takes an active role in CINRG, as Medical Director and study chair for multi-center protocols developing treatments for muscular dystrophy. In 2020, Dr. Clemens was awarded an NIH R21 grant to fund a pilot trial of vamorolone as treatment for Becker muscular dystrophy. Dr Zivkovic will be site-investigator for 2 more studies for experimental treatment of TTR amyloidosis. Dr. Lacomis will continue to follow up the patients with myasthenia gravis that have been enrolled in the PROMISE-MG study.