Introduction: Rasmussen Encephalitis is rare. Its facets are intractable seizures and progressive hemiparesis. We report the outcome of a case who fulfilled the diagnostic criteria   without biopsy and is on conservative management.

Case description: A five year right handed girl presented with focal clonic drug resistant seizure and progressive paresis of face and upper limb of left side.EEG showed focal high voltage delta waves over Right cerebral hemisphere. One year back the child had onset of focal seizure involving left half of face. CT cranium was normal. She was put on Phenytoin.  As seizures progressed to involve left upper limb, carbamazepine was added.  MRI at 8 months showed nonspecific white matter lesion in corona radiata. Along with the seizures, child developed progressive weakness of same sites. A repeat MRI after 4 months showed involvement of Perisylvian gyri, adjacent white matter and caudate nucleus of Right side without contrast enhancement. She was managed with immunosuppressants (Five days of methyl prednisolone 20 mg/kg /day, IV immunoglobulin 1gm/kg for 2 days) along with ongoing five antiepileptic drugs.Outcome:Her sensorium and weakness improved. Seizure frequency decreased. Antiepileptic drugs were slowly tapered.  She was discharged on leveteracetam and topiramate. She was put on monthly intravenous immunoglobulin. In last 2 months, she had more frequent seizures for which Clobazam was added. At the end of her 14^th month follow up, she has mild facial weakness and seizures are persistent.