Pushpa Narayanaswami, MD, Receives 2026 AANEM Distinguished Physician Award

Pushpa Narayanaswami, MD, traces her path to NM medicine back to her residency at the National Institute of Mental Health and Neurosciences (NIMHANS) in Bangalore, India, where a required doctoral thesis sparked a lifelong focus. "During my neurology residency...we were required to choose a topic for a doctoral thesis. I was drawn to neuromuscular disorders because of the clarity they offered in clinical localization—through a careful history and examination, complemented by electrodiagnostic studies and, when needed, muscle and nerve biopsies." At that time, genetic testing was not yet available, making clinical reasoning central to diagnosis.

As research on glutamate excitotoxicity in amyotrophic lateral sclerosis (ALS) emerged in the late 1980s, her thesis examined glutamate levels in the serum and cerebrospinal fluid (CSF) of patients with classical ALS as well as benign variants seen in India. What began as a broad interest in neurology evolved into a focused commitment to NM medicine, shaping her identity as a clinician.

Dr. Narayanaswami describes herself as "first and foremost, a clinician," emphasizing that her work has always been grounded in questions raised at the bedside. Early in her career, she sought to understand why some ALS-like conditions followed a more benign course, exploring whether differences in glutamate excitotoxicity might explain this variability and inform care. That focus on clinically meaningful questions has remained constant throughout her career.

Among the most meaningful aspects of her work has been caring for women with neuromuscular disorders—primarily myasthenia gravis and other autoimmune NM disorders—through pregnancy. "Probably the most meaningful reward of my career has been seeing children born to women with neuromuscular disorders," she said. Many of these women, she notes, "were told they should not or could not have children," or faced uncertainty about risks to themselves and their babies. "It has been deeply gratifying to support them through these journeys and to see their children grow and thrive," she said. "Nothing is more rewarding than when they return for visits and I get to see these children flourishing—even learning to use the reflex hammer on their mothers!"

Her clinical focus has evolved alongside advances in the field. Early exposure to muscular dystrophies during her training in India drew her deeper into NM medicine, and the advent of genetic testing brought greater diagnostic precision. Today, her practice is increasingly centered on myasthenia gravis, a condition she appreciates for its treatability and variability. "Over time, my practice has increasingly centered on myasthenia gravis, while still encompassing a broad range of neuromuscular disorders," she said. "It is a field I find intellectually rich and deeply rewarding for its direct impact on peoples' lives."

A few core principles define Dr. Narayanaswami's approach to patient care. "Above all, put the patient first," she said. "Staying anchored to that principle keeps me focused on what matters most in my work and helps cut out the noise." She also emphasizes the importance of reassessment when clinical findings do not align. "When the pieces do not quite fit, my strategy is to step back, start over, and look carefully for the missing piece," she said. Just as important is ensuring patients feel heard. She routinely asks, "Do you have any other questions for me?" or "How are you coping with all of this?"—questions that create space for patients to share concerns and help build trust.

Throughout her career, her relationship with the AANEM has been central. "The AANEM has been my professional home for over 30 years. I began reading Muscle & Nerve during my residency in 1986 and became a junior member of the AANEM as soon as I started my training in the United States in 1995," she recalled. She received junior member scholarships to present her work at AANEM meetings and has since served the organization in numerous leadership roles, including committee memberships, the Board of Directors, and as an Associate Editor of Muscle & Nerve. "This organization is my neuromuscular family," she said. "Receiving this prestigious award from the AANEM, the premier organization for neuromuscular medicine and electrodiagnosis, feels surreal. It represents an acknowledgment of what has been a labor of love, and I am deeply moved, humbled, and honored. It is my most cherished recognition."

Looking ahead, Dr. Narayanaswami remains focused on advancing patient care and supporting the next generation of NM specialists. "I have been profoundly blessed by this community. If I have a mission now, it is to give back what I have received so abundantly—by encouraging, supporting, and standing behind the next generation of neuromuscular neurologists, just as others once did for me," she said. She also expressed heartfelt gratitude to her family. "To my family—my sisters, my brother-in-law, my children, and my three grandcats—I owe an immeasurable debt of gratitude for their love, patience, and understanding through long working hours and many absences. Their support has made everything possible."