19-year-old African American female with seizures was transferred from a psychiatric hospital where she presented with catatonia and behavioral changes. Antiepileptic treatments were initiated for partial SE as identified from clinical seizures and vEEG monitoring. Workup confirmed a diagnosis of anti-NMDAR encephalitis related to ovarian teratoma. Subsequently, the patient received ovarian surgeries, immune-modulating treatments (IV steroid, IVIG, plasma exchange, etc.), and cytotoxic drugs. Unfortunately, her SE was refractory to AEDs and general anesthesia. She developed severe multi-organ dysfunction, especially liver failure, which endangered ongoing treatments. When regular options were exhausted, extended-duration TTM with gradual rewarming was utilized for 25 days (15 days of TTM and 10 days of gradual rewarming), during which the patient had no SE and remained seizure-free for 10 days with significantly reduced seizure frequency. Liver function recovered and other systemic dysfunctions resolved. Repeated MRI's during this time did not show any acute seizure related changes. No significant hypothermia-related complications were noted.