New-onset refractory status epilepticus (NORSE) and its subcategory febrile infection-related epilepsy syndrome (FIRES) are rare devastating clinical presentations in those without pre-existing relevant history, often in schoolchildren or young adults, without a clear cause on initial investigations. A cause may later be identified in up to half of them. NORSE can rarely occur as a consequence of COVID-19. NORSE can be defined as refractory status epilepticus in patients without history of seizures and without a clear acute or active structural, toxic or metabolic cause. The most commonly identified cause of NORSE is autoimmune encephalitis. Patients with refractory status epilepticus caused by anti N-methyl-D-aspartate receptor (NMDA) encephalitis without lung involvement have been recently reported in COVID-19 patients such as probable autoimmune encephalitis and encephalomyelitis. NMDA encephalitis is one of the most frequent cause of autoimmune encephalitis and it may be triggered by viral infections, particularly Herpes Simplex Virus. NMDA encephalitis was reported more than a decade ago, a classical patient usually is a young lady with psychiatric symptoms, refractory seizures, dyskinesia, autonomic instabilities and respond well to immunotherapy IVIG, plasma exchange and rituximab. First Indian case was reported a couple of years later from Kochi - a patient with refractory seizures on ventilator who responded well to immunotherapy [6]. Early initiation of immune therapy (steroids, intravenous immunoglobulins, and plasma exchange) is recommended for autoimmune encephalitis-related NORSE treatment and a delay in treatment often contributes to worse outcome.
