Recognition of DWM is of utmost importance for the neurologist and general practitioner, as this is a frequently missed sign also by expert eyes especially when occurring without cortical involvement. When DWM occurs in the context of seizures NKH is the first etiological process to think of, followed by Encephalitis (mostly anti-MOG). DWM carries diagnostic and therapeutic implications: anti-seizure medication is not the first line of treatment in NKH-associated seizures, but rather the correction of the hyperglycaemic state. Moreover, NKH needs to be suspected in the presence of DWM even when only HbA1c, rather than glycemia, is markedly elevated.