62-year-old male presented with complaints of right face and tongue twitching and numbness. MRI brain C+/C- showed T2 hyperintensity changes in bilateral temporal lobes, right frontal lobe, adjacent left motor and sensory strips in the low to mid convexity region. Lumbar puncture showed mild pleocytosis. He was treated empirically with ceftriaxone, vancomycin and acyclovir for bacterial/viral encephalitis. EEG showed bilateral cortical irritability, left worse than right however the right facial twitching had no electrographic correlate. After being discharged on 2 anti-seizure drugs (AED) he returned 2 months later with left facial and left arm intermittent twitching with changes in mental status. EEG revealed refractory focal onset in right posterior temporal/occipital region with secondary generalized seizures. He was treated with propofol, midazolam and pentobarbital. Repeat MRI showed migratory multifocal encephalitis R>L hemisphere. Repeat lumbar puncture showed pleocytosis with increased protein. Pulse steroids were initiated following oral prednisone. Confirmatory results revealed GAD-65 antibody and patient was treated with 2 courses of IVIG followed by 3 doses of basiliximab. 4 months after initial presentation his mental status improved. He was awake, alert, tracked and regarded. He was discharged on 4 AEDs. He received 2 more doses of immunotherapy as outpatient with ongoing improvement.