A combined model incorporating twelve predictors (Ocular symptoms, Gastrointestinal symptoms, Water swallowing and choking difficulties, Cerebral lobes, Centrum semiovale, Brainstem, Cerebral ganglia, Spinal cord, APOA1, Ca, Toxoplasma gondii IgM Antibody, CSF IgG) achieved an AUC of 0.936in the training cohort and 0.929 in external validation.<h4>Discussion</h4>AQP4-IgG-negative NMOSD shows distinct clinical, imaging, and laboratory profiles compared to other nervous system autoimmune disorders. Here, AQP4 is linked to autoimmune disorder of the nervous system.