The recurrence rate of anti-NMDA receptor encephalitis is around 10-20% and is becoming a new challenge in the treatment of this disease. Recurrence may be related to factors such as underlying teratomas not being detected and resected, irregular immunotherapy especially long course immunotherapy is not applied enough. Guan Hongzhi et al. summarized the clinical features and treatment options of 16 cases of recurrent anti-NMDA receptor encephalitis disease. Among the 16 recurrent cases, 5 were male and 11 were female, with an average age of 21.2 years. The first onset symptoms: psychiatric symptoms in 10 cases, involuntary movements in 2 cases, seizures in 3 cases, and near memory loss in 1 case. Number of major symptoms: 2-8, mean 5.8, 7 cases (43.8%) admitted to ICU for treatment. mRs score mean 4.56. 1 case found ovarian teratoma and resected in parallel, all cases in remission after immunotherapy. Among the 32 recurrences, 28 cases had milder disease than the first, 3 cases had the same severity as the first, 1 case had more severe disease than the first, and 2 cases were admitted to ICU. The mean number of symptoms in the relapse period was 2.59 per case, which was lower than the mean number of symptoms in the first episode (P<0.05)< span="">. The relapse period mRs score was 1-5, with a mean of 2.69 (P<0.05)< span="">. 2 cases had new symptoms at the time of relapse that were different from those at the time of first onset. Adjunctive findings during relapse: cerebrospinal fluid anti-NMDA receptor antibody positivity rate was 100%, and serum anti-NMDA receptor antibody positivity rate was 53.1% (17/32). EEG during relapse: 12 cases with abnormalities and 2 cases with borderline status. Head MRI was abnormal in 8 cases in the first onset examination, and the original lesions disappeared in relapse, and new lesions were seen in 7 cases. Head PET: 5 cases had head PET performed at the relapse stage, and all had abnormalities. Treatment at the relapse stage: 2 cases of ovarian teratoma were found at the relapse stage and surgically removed. 16 cases were given first-line immunotherapy and 12 cases were given second-line immunotherapy, including azathioprine, primaquine, melphalan and cyclophosphamide. All cases were in remission after immunotherapy. Conclusion Anti-NMDA receptor encephalitis has the potential for both primary and multiple relapses, and relapse is still possible even after removal of teratoma. Most patients have mild symptoms at the time of recurrence. Symptomatology, cerebrospinal fluid antibody testing, and neuroimaging are important methods to determine and assess recurrence. To prevent recurrence, the choice of a long course of immunotherapy regimen is necessary and needs to be followed on an individualized basis.