Refining Myelitis Criteria to Reduce Misdiagnosis and Improve Care in Clinical Practice

Inflammatory myelopathies represent a heterogeneous group of spinal cord disorders with diverse etiologies, overlapping phenotypes, and important therapeutic implications. Over the past 2 decades, the discovery of biomarkers such as aquaporin-4 antibodies and myelin oligodendrocyte glycoprotein (MOG) antibodies, along with improved imaging characterization, has underscored the limitations of legacy diagnostic terms and frameworks. In particular, the historical use of “transverse myelitis” as a catch-all label has raised concern for premature diagnostic closure and missed opportunities for etiology-directed management.

At the 2026 Consortium of Multiple Sclerosis Centers (CMSC) Annual Meeting, held May 27-29, Charlotte, North Carolina, neurologist Kyle Blackburn, MD, an assistant professor of neurology at UT Southwestern Medical Center, presented a session titled “Updates to Diagnostic Criteria and Nosology for Myelitis.” In his talk, Blackburn outlined proposed updates to consensus criteria for inflammatory myelopathies and emphasized a shift toward the syndromic term “myelitis” instead of “transverse myelitis.” These refinements are intended to better distinguish inflammatory myelopathies from noninflammatory myelopathies and mimics, to encourage earlier and more comprehensive diagnostic workup.^1,2

In a recent interview with NeurologyLive^®, Blackburn elaborated on the rationale behind revising the terminology and diagnostic algorithms, including how advances in antibody testing and imaging have driven the need for updated criteria. He also discussed how adopting “myelitis” as a syndromic construct may help clinicians think more systematically about etiology, asking what specific descriptor should precede “myelitis,” or whether the presentation instead reflects a noninflammatory myelopathy altogether. The conversation further explored the potential impact of these changes on real-world clinical practice, early referral patterns, and future research in inflammatory spinal cord disease.

NeurologyLive: How have advances in diagnosing rare autoimmune conditions influenced the push to update the terminology and the diagnostic criteria?

Kyle Blackburn, MD: That was one of the primary drivers for updating the criteria. Our last consensus statement on diagnosing inflammatory myelopathies was from 2002, and things like aquaporin-4, which is the NMO antibody, were discovered in 2005. MOGAD was about another decade later.

But even beyond the inflammatory causes, some of the mimics—things that can look like myelitis but wind up being noninflammatory—the imaging clues around what might be a mimic were also better refined in the literature. There was just this critical mass of work defining new causes of inflammatory myelopathies and myelitis, and defining the mimics a little better. That was really one of the primary aims was to update the diagnostic algorithms and to update clinicians seeing these patients on a more modern approach to diagnosing these patients and considering these new etiologies.

Why is moving away from the term “transverse myelitis” considered important for improving research studies and patient care?

This was something that our working group really felt passionate about, and there’s even an undercurrent already of people using the term “myelitis” out in the community. What really worried many of our physicians on our working group was that patients would be referred to these tertiary referral centers with a diagnosis of transverse myelitis, which is often shorthand for idiopathic transverse myelitis.

Some of the literature shows that those patients many times will have that diagnosis refined at the tertiary referral center. Either we would find another inflammatory cause—many of which would require ongoing treatment and a change in their plan—or we’d find a mimic. Some of the mimics also have a treatment approach to minimize worsening of the condition.

We discovered that “transverse myelitis” almost seemed to be this area where premature closure of the diagnosis would happen in the community. We felt that by changing the term and moving away from “transverse myelitis”—and we have proposed using “myelitis” to define inflammatory myelopathies as a syndrome—in doing that, we are hoping to rejigger that conversation and get clinicians to think, “Okay, if this patient has myelitis, what adjective should I be trying to put in front of that? Or should I be talking about myelitis at all—is it just a myelopathy with another cause?” We’re hoping that by reviving this term “myelitis,” we can encourage clinicians in the community to do the workup sooner, a full workup sooner, and that will only help our patients in the long run.

We’re also hoping to standardize the nomenclature in the literature. A lot of the papers that write about inflammatory myelopathies have adopted other terms, in part because the 2002 criteria just need an update. The papers sometimes use different criteria or propose their own criteria, and we’re hoping to standardize this in the literature so that we can get a better understanding of what the full spectrum of inflammatory myelopathies looks like and which patients seem more likely to have a mimic. It’s just going to help us have better epidemiologic study of these inflammatory myelopathies.

What do these updated definitions and diagnostic approaches mean for clinicians who may be helping patients with suspected inflammatory spinal cord disorders?

Our hope is that for the clinicians who are the first to see these patients, it will provide them with a more fluid way of arriving at an accurate diagnosis sooner—that’s really what it boils down to. We created new criteria for what we would define as myelitis, so a clinician can look at their patient and say, “Do I have enough information to say that this looks like an inflammatory myelopathy, or should I be considering a mimic?” With our new updated diagnostic algorithms, we’re hoping that clinicians will be able to arrive at that more accurate diagnosis sooner, start a more tailored treatment plan sooner, or get the patient to a tertiary referral center—if that’s truly what’s going to be needed—earlier in the process.

Transcript edited for clarity. Click here for more coverage of CMSC 2026.

REFERENCES
1. Blackburn K. 2025 Updates to Diagnostic Criteria and Nosology for Myelitis. Presented at: 2026 CMSC Annual Meeting; May 27-29; Charlotte, North Carolina. Managing Non-Multiple Sclerosis Patients in a Multiple Sclerosis Practice: Rare Neuroimmunological Disorders – Everything You Need to Know Part 1.
2. Blackburn KM, Greenberg BM. Revisiting Transverse Myelitis: Moving Toward a New Nomenclature. Front Neurol. 2020;11:519468. Published 2020 Sep 23. doi:10.3389/fneur.2020.519468