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Multiple sclerosis (MS) and neuromyelitis optica spectrum disorders (NMOSD) are autoimmune demyelinating diseases of the central nervous system. Neuromyelitis optica was considered a variant of MS until the discovery of NMO-IgG in 2004, which changed our understanding of the pathophysiology of NMOSD. This review focuses on the similarities and differences in the immune treatments of MS and NMOSD.