Background <p>Neuromyelitis optica spectrum disorder (NMOSD) is an inflammatory disorder of the central nervous system (CNS) predominantly affecting the optic nerves and spinal cord, should be considered as a differential diagnosis in all patients presenting with acute optic neuritis and/or acute attacks of transverse myelitis. </p> Case presentation <p> This report describes a female patient presenting with recurrent optic neuritis and was diagnosed as neuromyelitis optica spectrum disorder, were all the traditional acute therapies failed, while repetitive transcranial magnetic stimulation shows an effective response on severe visual affection following recurrent attacks of optic neuritis.</p> Conclusion <p>Repetitive transcranial magnetic stimulation (rTMS) may be considered as a potential therapeutic strategy for refractory visual impairment in NMOSD.</p>