AQP4-NMOSD may present with severe optic neuritis, longitudinally extensive transverse myelitis, and area postrema, brainstem, diencephalic, and cerebral syndromes.1,4 The prompt distinction between MOGAD, AQP4-NMOSD, and multiple sclerosis (MS) may be challenging for clinicians because the diseases share some clinical and magnetic resonance imaging (MRI) characteristics, which may hamper the treatment of patients. This evidence concerns the gene AQP4 and multiple sclerosis.