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Area postrema (AP) is one of the most common involved area of NMOSD, which may have a particular significance in the pathogenesis of NMOSD and clinical heterogeneity. Our study is to investigate the clinical and recurrent characteristics AP onset NMOSD patients.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>A retrospective study was done in a cohort of 166 AQP4-IgG seropositive NMOSD patients which were identified by the 2015 IPND criteria. The patients were divided into AP onset (APO-NMOSD) group and non-AP onset (NAPO-NMOSD) group based on the initial episode location. Clinical features and recurrence differences of two groups were compared.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>The APO-NMOSD group and NAPO-NMOSD group had a population ratio of 24:142. APO-NMOSD patients were younger (34.6y VS 42.3y, <jats:italic>P<\/jats:italic>\u2009=\u20090.013), had lower EDSS at first episode (0.7 VS 4.2, <jats:italic>p<\/jats:italic>\u2009=\u20090.028) and last follow up (1.9 VS 3.3, <jats:italic>p<\/jats:italic>\u2009=\u20090.001), more likely to have multi-core lesions at the first attack (33.3% VS 9.2%, <jats:italic>P<\/jats:italic>\u2009=\u20090.001). Also, they had a higher annual recurrence rate (0.4\u2009\u00b1\u20090.28 VS 0.19\u2009\u00b1\u20090.25, <jats:italic>P<\/jats:italic>\u2009=\u20090.012). In natural course NMOSD patients without immunotherapy, APO-NMSOD had a shorter time of first relapse (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001) and higher annual recurrence rate (0.31\u2009\u00b1\u20090.22 VS 0.16\u2009\u00b1\u20090.26, <jats:italic>P<\/jats:italic>\u2009=\u20090.038) than NAPO-NMOSD. APO-NMOSD group also have a higher risk of having the first relapsing compared to optic neuritis onset-NMOSD (HR 2.641, 95% CI 1.427\u20134.887, <jats:italic>p<\/jats:italic>\u2009=\u20090.002) and myelitis onset-NMOSD group (HR 3.593, 95% CI 1.736\u20137.438, <jats:italic>p<\/jats:italic>\u2009=\u20090.001). Compared to NAPO-NMOSD, APO-NMOSD has a higher likelihood of brainstem recurrence (28.6% vs. 4.7%, <jats:italic>p<\/jats:italic>&lt;0.001) during the first recurrence, while NAPO-NMOSD is more susceptible to optic nerve involvement (10.7% vs. 41.1%, <jats:italic>p<\/jats:italic>\u2009=\u20090.01).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>AQP4-IgG seropositive NMOSD patients with AP onset are youngers and have higher risk of recurrence. Clinicians should pay attention to AP damage in NMOSD, as it indicates a potential risk of recurrence.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Trial registration<\/jats:title>\n                <jats:p>Retrospectively registered.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12883-024-03667-3","type":"journal-article","created":{"date-parts":[[2024,5,21]],"date-time":"2024-05-21T06:01:38Z","timestamp":1716271298000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Characteristics of recurrence in area postrema-onset NMO spectrum disorder - a retrospective cohort study"],"prefix":"10.1186","volume":"24","author":[{"given":"Xianxing","family":"Zhang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jin","family":"Wu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jingyu","family":"Lin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shifang","family":"Lin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8841-2362","authenticated-orcid":false,"given":"Aiyu","family":"Lin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,5,21]]},"reference":[{"issue":"5","key":"3667_CR1","doi-asserted-by":"publisher","first-page":"1107","DOI":"10.1212\/WNL.53.5.1107","volume":"53","author":"DM Wingerchuk","year":"1999","unstructured":"Wingerchuk DM, Hogancamp WF, O\u2032Brien PC, et al. 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