Background <p>Anti-N-methyl-D-aspartate receptor encephalitis is a severe neurological disorder. While standard treatments work for many patients, up to 25% are resistant to these treatments. In such challenging cases, there is growing interest in using intrathecal approaches.</p> Methods <p>A narrative review of relevant papers was conducted.</p> Results <p>Case reports and case series have demonstrated the successful use of intrathecal methotrexate, either alone or in combination with steroids, particularly in pediatric patients. Additionally, intrathecal rituximab has shown promise in select cases.</p> Conclusions <p>Although outcomes vary, this approach appears to be safe and has the potential to rescue refractory cases.</p>