I am a specialist in paediatric neurodisability working in the UK and Sri Lanka.

As well as treating neurology patients I have particular expertise in managing children with complex neurological illnesses including developmental delay, developmental regression, cerebral palsy, autism, learning difficulties, complex epilepsy and ADHD.

I've gained specialist skill in treating children with cerebral palsy with Botulinum toxin (Botox) under ultrasound guidance for both upper and lower limbs with more than 10 years' experience in the field. I also lead the "Botox" service at Imperial College Healthcare (formerly St. Mary's), London.

At Imperial College Healthcare I lead the Multidisciplinary Neurodisability Service. I have also worked at Great Ormond Street Hospital for Children, London and been an Honorary Senior Lecturer in Child Health, Imperial College School of Medicine, since 2004 and am actively involved in teaching medical students and doctors undertaking paediatric postgraduate training. I'm also an Examiner to the Royal College of Pediatrics and Child Health.


Services

Diagnosis, investigation and management of complex neurology and developmental disorders including:

  • developmental delay
  • developmental regression
  • cerebral palsy
  • autism
  • learning difficulties
  • complex epilepsy
  • ADHD

Clinics

I am available for private consultations at the following clinics
  • The Portland Hospital, London
  • The Child and Family Practice, London
  • Lanka Hospitals, Colombo

See Contacts for details.

I will next be available for consultation in Colombo 29 Sep-18 Oct 2017

My Background

I'm a specialist in paediatric neurodisability based in the UK.

Paediatric neurodisability is a new sub-speciality in the UK whereby consultants receive training in both neurology and more importantly in-depth training in diagnosis, investigation and management of complex neurology and developmental disorders.

As well as treating neurology patients I have particular expertise in managing children with complex neurological illnesses including developmental delay, developmental regression, cerebral palsy, autism, learning difficulties, complex epilepsy and ADHD.

I used to lead the Somerset multidisciplinary autism service where I became skilled in using 3Di, DISCO and ADOS assessment tools.

I also pursued further training in reading paediatric EEG’s this has helped me to tailor the medication required for children with complex epilepsy.

I have also gained specialist skill in treating children with cerebral palsy with Botulinum toxin (Botox) under ultrasound guidance for both upper and lower limbs, something I've been doing now for more than 10 years. I lead the "Botox" service at Imperial College Healthcare (formerly St Mary's), London.

I lead the Multidisciplinary Neurodisability Service at Imperial College Healthcare. I've also been an Honorary Senior Lecturer in Child Health, Imperial College School of Medicine, London, since 2004. I am actively involved in teaching medical students and doctors undertaking paediatric postgraduate training. I'm also an Examiner to the Royal College of Pediatrics and Child Health.

Private Practice

I accept referrals for assessment and treatment of complex neurological conditions at

  • The Portland Hospital, London
  • Child and Family Practice, 8 Ridgmount Street, London
and at
  • Lanka Hospitals, Colombo, Sri Lanka

Since 2005 I've been regularly visiting Sri Lanka to provide a service to the people of my native country.

For Botox treatment please contact the Child and Family Practice

See the Contacts page for information about these hospitals and how to make an appointment.

Languages

I'm fluent in both English and Singhalese (Sinhala).

My Qualifications

I received my primary medical degree from the Colombo Medical School in Sri Lanka. I then took specialist training which included general paediatrics, neonatology, neurology, neurodisability, and developmental paediatrics at a number of world-renowned centres including St. Mary's and at Great Ormond Street Hospitals in London, and at other centres in Germany and Belgium. I also received training in "Botox" treatment for children with spasticity in leading centres in the UK, Germany, USA and Belgium.

I'm a Fellow of the Royal College of Paediatrics and Child Health (RCPCH), a Member of the British Paediatric Neurology Association (BPNA), and a Member of the European Academy of Childhood Disability (EACD).

I was recently honoured to be appointed a Committee Member to the International Group of the American Academy for Cerebral Palsy and Developmental Medicine (AACPDM)

Research Interests

My primary research interest is in the treatment of motor disorders, including the use of Botulinum toxin in such treatment.

For more information on Botulinum toxin, see my Botox page.

Affiliations

  • Fellow of the Royal College of Paediatrics and Child Health (RCPCH)
  • Member of the British Paediatric Neurology Association (BPNA)
  • Member of the European Academy of Childhood Disability (EACD)
  • Committee Member to the International Group of the American Academy for Cerebral Palsy and Developmental Medicine (AACPDM)
  • GMC registration number 3376863

My Charity Work

[Tsunami camp] Although I decided to continue my postgraduate education in the United Kingdom, I have maintained my links with my native country by providing clinical services, educating junior doctors and performing charitable works there. After the 2004 tsunami in south Asia I spent my annual leave at a camp on the southern coast of Sri Lanka helping and treating children affected by the disaster. I treated children with various illnesses including acute illnesses such as gastroenteritis and chest infections. I quickly came to realise that the displaced children need a pre-school to continue their education and managed, with friends, to erect a small building for some of them.

Since 2001 I have been visiting Sri Lanka three times a year during my annual leave to treat children with varying neurological illnesses. I believe I provide an unbiased, clinically excellent service in Colombo. My patients have commend me on my committed service to my native country.

During 2011 my brother and I built a pre-school in a remote village in Sri Lanka.

[School in Sri Lanka]

We handed over this building to the local community in November 2011. Some of my friends in the United Kingdom and Canada helped towards this by providing financial assistance and toys for the school. I continue to strive to improve the health and education in pre-school children in Sri Lanka.



[School in Sri Lanka]

[School in Sri Lanka]

[School in Sri Lanka]

Botulinum Toxin (Botox)

In cerebral palsy, many of the muscles in the body are tight (spastic). This is because these muscles are receiving the wrong nerve signals from the brain and spinal cord. These “tight” muscles pull the legs and/or arms into abnormal postures, making certain movements difficult.

Children with cerebral palsy may have difficulty walking and/or sitting, and in using an affected hand or arm for every day activities.

What is Botulinum Toxin?

Botulinum Toxin is a protein produced by bacteria. The Botulinum bacteria itself are known to cause food poisoning if taken by mouth. However, the Botulinum Toxin used in these treatments is purified and administered in small doses by injection.

It is administered in a very controlled way by a Doctor who has had several years’ experience in the use of the drug.

How does Botulinum Toxin work?

Botulinum Toxin works by blocking the nerve signals which prevent the muscles relaxing. Botulinum Toxin is injected into individual muscles in the legs or arms with a small needle. Once the nerves in the area of the muscle have been blocked, the muscle can then relax.

The muscles injected may look and feel more relaxed within 24-48 hours. The muscles will be most relaxed approximately 6 weeks after the injection. Botulinum Toxin is active in relaxing the muscles for 4-6 months, if not longer. After this time, repeat injections may be required.

What happens at the Botulinum Clinic?

Each new patient attending the clinic will be carefully assessed at the first visit to see whether they would benefit from receiving Botulinum Toxin. If a decision is made to proceed with the treatment, your child will be offered a day case admission for his/her first set of injections.

Approximately 30 mins to 1 hour before the injections are administered a local anaesthetic cream is applied to the area to be treated. This is to ensure that the injections are as painless as possible. A light sedative will be given to children to reduce anxiety of the injection. Botulinum Toxin will then be injected into individual muscles. In some situations Botulinum Toxin may be given under a short general anaesthetic after discussion with you and your child.

Are there any side effects?

Treatment with Botulinum Toxin is very well tolerated by most children with cerebral palsy and is extremely safe. Children generally do not notice the needle when it is being positioned in the muscle, but following administration of Botulinum Toxin they may feel a slight stinging sensation. However, some children may experience some side effects, especially during the first few weeks following the injection. These are usually mild and temporary and may consist of a feeling of weakness with occasional reports of flu like symptoms. A few children worldwide have reported temporary incontinence, constipation or swallowing problems after injections.

Is there anything I can do?

Stretching the muscles will help to lengthen them and improve their function long after the effects of Botulinum Toxin have worn off. It is important that your child continues to receive his/her regular physiotherapy sessions and to wear any prescribed splints as usual after treatment of Botulinum Toxin. We would encourage normal activities as soon as possible after the injections.

If you have any queries before or after the Botulinum Toxin injections, please do not hesitate to contact Dr. Sunil Pullaperuma, Consultant in Paediatric Neurodisability.

Headaches

Headache is a common symptom in children, affecting 80-90% by age 18. Children as young as 3 years can have headaches. The common causes are: systemic illness with fever, ENT problems, migraine, and tension. In prepubertal children headaches occur with equal frequency in both boys and girls, but after puberty girls suffer from headaches two to three times more often than boys.

Most headaches aren't serious and can be treated with simple remedies and lifestyle changes, such as getting more rest and drinking enough fluids. Headaches have many different causes but can generally be split into two types:

Primary headache types in children include: migraine, tension-type headache, and cluster headache. Secondary headaches can be due to meningitis, raised intracranial pressure (ICP) caused by tumours, and subarachnoid haemorrhage (SAH). Fortunately secondary headaches are much rarer than primary headaches in children, but both do need to be considered during consultation.

Primary Headaches

Recurrent Headaches or Migraines

Migraine headaches are the most common type of headache among adolescents. Migraines typically occur 3-4 times per month, last from 1 to 24 hours, with a pain severity of moderate-to-severe. Throbbing pain affects front of the head on one or both sides. Migraine headaches can be associated with nausea, vomiting, and sensitivity to light and noise.

Migraine headaches tend to increase with increased physical activity. They can usually be relieved by sleeping in the quiet, dark room without any stimulation. Analgesics such as high dose Ibuprofen, or migraine specific medications, such as triptans, can relieve the headaches, and should be taken at the onset of the headaches to get the maximum benefit.

Tension Headaches

Tension-type headaches can cause pressure-type pain, as if a rubber band has been stretched around the forehead or back of the head/neck region. Tension headaches are very common (they're what we think of as normal everyday, headaches). Stress is one possible cause, but there are lots of others including: not getting enough sleep, skipping meals, and becoming dehydrated

Cluster Headaches

Cluster headaches are excruciatingly painful headaches, causing an intense pain around one eye. Fortunately, they're rare. They commonly occur in clusters for a month or two at around the same time each year. Over-the-counter medications don't ease the symptoms of cluster headaches, but a doctor can prescribe specific medications to ease the pain.

When to Consult a Paediatrician for Headaches

  1. Headaches that require a child to take two or more analgesics per week.
  2. Headaches that wake a child at night on a regular basis. (It's important to rule out any secondary cause for the headache)
  3. Headaches that are frequent or prolonged and affect school performance or social activities
  4. The presence of unusual neurological symptoms associated with headaches such as:
    • Unsteady gait
    • One sided weakness
    • Prolonged numbness of the one side of the body
    • Inability to speak
    • Confusion and agitation
    • Recent development of new neurological symptoms such as double vision, blurry vision, difficulty to speak, neck stiffness
    • Recurrent projectile vomiting
    • Recent head trauma

Headache Hygiene

There are number of lifestyle changes that may help to reduce the frequency of your child's headaches.

  1. Sleep Habits
    • Go to bed and wake up at a regular time each day and get enough hours of sleep every night
    • Avoid excessive sleep on the weekends or too little sleep on the week days
    • Avoid computer, game, TV other electronics in bed which can delay falling asleep
    • Create a calm atmosphere in the bedroom without bright light or loud noise
  2. Meals
    • Eat regular meals, including breakfast, every day
    • Eat nutritious meals every day containing protein, fruits, vegetable and carbohydrates
    • Drink plenty of water throughout the day. (Dehydration can worsen the headaches.)
    • Limit caffeinated drinks such as tea, coffee, cola and energy drink.
  3. Food Triggers
    • Avoid potential food triggers including chocolate, cured meat (ham, bacon, salami etc.), cheese and processed foods
  4. Exercise
    • Exercise regularly, in moderation it will help to reduce stress and so help with headaches
    • Find time to relax to reduce stress

Preventive Medications

If headaches are frequent or prolonged, your child may benefit from preventive medications. It may take one-to-two months for any preventive medicine to start having an effect.

Secondary Headaches

These include headaches that come on with another illness such as a cold or flu, an allergic reaction, sinus problems or (rarely) due to increased pressure in the head caused by a tumour or a bleed.

Medication and Painkiller Headaches

Headaches are a side effect of taking certain medications. Frequent headaches can also be caused by taking painkillers too often.

Temporomandibular Joint Disorders (TJD)

Headaches are one of the symptoms of disorders of the temporomandibular joint. The affected joint is between the lower jaw and the base of the skull. It has been estimated that approximately 20-30% of the adult population will experience a TJD at some point; children can also experience such headaches, but it's uncommon. Symptoms usually last for a few months before getting better.

How can I help?

My team at I the Child and Family Practice in London run a special clinic for children with headaches. Here I can diagnose whether your child has primary or secondary headaches and can arrange essential investigations including blood tests, EEG's and MRI brain scans as necessary. Following consultation I will be able recommend a treatment plan including headache hygiene and preventative medications. The team includes a child psychiatrist and a clinical psychologist who can help with the treatment if needed.

Selective Dorsal Rhizotomy (SDR)

Mr Kristian Aquilina, Paediatric Neurosurgeon (Great Ormond Hospital for Children, London) and Dr Sunil Pullaperuma lead the Selective Dorsal Rhizotomy multidisciplinary service at The Portland Hospital.

Selective Dorsal Rhizotomy (SDR) was first developed in 1898, but has become more popular over the last 30 years as techniques have advanced. It's a neurosurgical procedure aimed at reducing spasticity (tight and stiff muscle tone) in the lower limbs. It's most commonly used for children with spastic diplegia (two limbs affected) which accounts for 25-30% of children born with cerebral palsy. Children with this condition can find it very difficult to walk due to a constant stiffness (spasticity) in both lower limbs.

The surgery requires the bones of the spine (vertebrae) in the lower back area to be opened to reveal the conus (the end of the spinal cord) and gain access to the nerve roots that needed to be divided. The traditional approach was to access these roots via a lengthy, multi-level operation gaining access to the nerves by opening several vertebrae. However, some evidence suggests the multi-level approach may lead to other spinal problems such as scoliosis. By its nature it is an irreversible procedure, but SDR has been shown to have long term benefits including a reduction in spasticity and improved movement and gait with improved quality of life for both the child and their family.

Appropriate selection for SDR

Appropriate selection for SDR is key to its success, so a comprehensive assessment by a skilled multidisciplinary team is essential to ensure that this procedure is right for your child. The team should comprise a paediatric neurosurgeon, a consultant paediatrician in neurodisability, and a physiotherapist specialised in children's movement disorders. In the UK, NICE (the National Institute of Clinical Excellence) has issued guidance demonstrating that SDR is most effective for children between 4 and 10 years of age. In America the surgery may be performed on younger children.

In the UK SDR is not generally considered when a young person has any of the following:

Assessment

If you would like us to perform an SDR assesment for your child, we would initially need to see your child's medical records, including a recent physiotherapy report, an MRI scan of the brain and a recent hip x-ray.

If the multidisciplinary team feels that your child may be suitable for SDR, the next step will be to book an assessment with the team. The child will undergo a full assessment and there will also be a discussion of the expected benefits and risks of SDR as well as a review of post-operative physiotherapy needs.

Spasticity management can be complex and therefore if it is felt that your child is not suitable for SDR then other options will be considered. These include botulinum toxin injections in conjunction with physiotherapy, baclofen pump insertion, and orthopaedic surgery, all of which will be carefully discussed before any further treatment.

Should you wish your child to be considered for SDR at The Portland Hospital and for details of prices please email SDRportland@hcahealthcare.co.uk or call our dedicated team on +44 (0)20 3733 7625.

Testimonials

Dr Pullaperuma treated our daughter over the course of two years for childhood absence seizures. It was a very anxious time for my wife and I but Sunil was always kind and gentle with our daughter and very understanding with our numerous questions and concerns. We have recommended him to two friends and they have found him to be excellent too.

- NB

 

Myself and my family have known Dr Pullaperuma for a number of years as he has been treating my son for a very rare condition which my family had never heard of. The condition is know as Pelizaeus-Mezbacher Disease once again I state rare progressive degenerative central nervous system disorder. Dr Pullaperuma has done we feel a very good and thorough job in searching to find out what was wrong with my son, and we would like to say he works very hard in finding out what is wrong then treating the person the best way he knows. A big thank you from

- J & J

 

Visits to Dr Pullaperuma bring great assurance and help us progress with son's development in the best way we possibly can. His recommendations on treatments, education and therapies have brought my child on beautifully. Dr Pullaperuma diagnosed early on (age 2) my son's condition which was confirmed via an MRI. He helps us manage and deal with the condition in the best possible way

- Mrs. S

 

"Much credit is due to Dr Pullaperuma. I have been most impressed with the way in which he has dealt with my daughter. He has always been at the end of an email or a phone call to answer any questions I have had with my daughters treatment. His incredible knowledge of her situation has made me very comfortable with her treatment and his continued guidance is most valuable."

- Sehar

 

 

The Portland Hospital

The Child and Family Practice

Lanka Hospitals

Address

205-209 Great Portland Street
London
W1W 5AH
8 Ridgmount Street
London
WC1E 7AA
578
Elvitigala Mawatha
Narahenpita
Colombo 5
Sri Lanka

Website

The Portland Hospital The Child and Family Practice Lanka Hospitals

For private appointments:

Telephone

+44 (0)207 390 6504 +44 (0)20 7637 7697
or +44 (0)7964 327453
Tel. +94 114 530000

Email

sunilprivate@hotmail.co.uk sunilprivate@hotmail.co.uk -

Getting here:

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By public transport

Tube stations Regents Park (Bakerloo Line) and Great Portland Street (Cirle/Metropolitain Lines) are both a short walk from the hospital. Googe Street (Northern Line) is the closest tube station. Travelling towards Borella, Lanka Hospitals is between Park Road and Kirula Mawatha junctions on Baseline (Elvitigala) Road.

By car

The most convenient car parks are NCP in Carburton Street and Union Carparks in Devonshire Row Mews Upper Street Car Park is the closest.