Patients with suspected encephalitis continue to represent a diagnostic and therapeutic challenge, even in highly resourced centres. In February 2018, we set up a monthly in-person multidisciplinary team meeting (MDT). We describe the experience and outcomes of the MDT over three years. A retrospective analysis was performed to summarise patient demographics, MDT outcomes and final diagnoses. Over the three-year period, 324 discussions of 238 patients took place. Cases were diverse; approximately 40% related to COVID-19 or brain infection, 40% autoimmune or other inflammatory disorders and 20% encephalitis mimics or uncertain aetiologies. Feedback from an online survey sent to referring teams and attendees highlighted the value of the MDT; 94% reported the discussion was useful and 69% reported resulting change in patient management. Multidisciplinary input is crucial in this challenging area, ensuring that all diagnostic avenues are explored and opening doors to novel diagnostics and therapeutics. It also supports clinicians dealing with unwell patients, including in centres where less specialist input is available, and when decisions have to be made where there is little or no evidence base. •Suspected encephalitis cases are frequently challenging to diagnose and treat, often in evidence-free zones.•A regular MDT in a tertiary care centre enabled multidisciplinary input with open dialogue and formulation of management plans.•We urge closer working relationships between centres, and incorporation of referral to these centres in national guidelines for special cases.•There is also a need for robust collection of observational data from treatment decisions made by the MDT to inform future decision making.