BACKGROUND: Studies in MS and NMOSD have shown that relapses can frequently occur in the same location as the first attack. Factors associated with this outcome in MOGAD are unclear. OBJECTIVE: The objective of this study was to investigate the likelihood of a relapse occurring at the same site in MOGAD. METHODS: This was a UK national cohort study. MOGAD patients with a minimum of one relapse and one year of follow-up were included. To identify factors associated with relapse location, logistic regression was performed. RESULTS: An increased risk of a relapse in the same location was observed when the first attack was optic neuritis-for the second attack (OR 12.9, 95% CI 3.31-50.55, p = .001) and all subsequent attacks (OR 5.39 95% CI 1.61-18.03, p = .006). Conversely, a reduced risk of relapse in the same location was associated with transverse myelitis-for the second attack (OR 0.25, 95% CI 0.07-0.82, p = .022) and all subsequent attacks (OR 0.25 95% CI 0.06-0.96, p = .045). CONCLUSION: In relapsing MOGAD, patients with optic neuritis are at high risk of a new attack in the same location, while those with transverse myelitis are at low risk.