An unusual cause of school refusal

A 6-year-old school boy was brought to the child developmental specialist with complaints of school absenteeism and school refusal behaviour of 7 months duration. Before the onset of school refusal, he had two episodes of unresponsiveness with abnormal posturing preceded by vertigo, which were diagnosed and managed as epileptic seizures. Following these episodes, he started avoiding school due of episodic palpitations, 'nervousness' and sweating. However, the episodes of unresponsiveness did not recur. His symptoms were attributed to stress/anxiety by both the examining physicians as well as the parents because repeated clinical evaluation including 12-lead ECG done three times and echocardiography were normal. Fortunately the sixth time, the diagnosis was clinched on an ECG when he presented to the paediatrician with tachycardia and hypotension.