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
I will next be available for consultation in
Colombo t.b.a.
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
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.
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.
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 headaches - those not caused by some underlying
medical condition
Secondary headaches - those due to a separate cause, such as
illness
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
Headaches that require a child to take two or more
analgesics per week.
Headaches that wake a child at night on a regular basis.
(It's important to rule out any secondary cause for the headache)
Headaches that are frequent or prolonged and affect school
performance or social activities
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.
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
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.
Food Triggers
Avoid potential food triggers including chocolate, cured
meat (ham, bacon, salami etc.), cheese and processed foods
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:
hip dislocation and fixed muscle-tendon contractures
mixed type cerebral palsy with dystonia, athetosis or
ataxia
scoliosis (curvature of spine)
acquired brain or spinal injury such as meningitis,
congenital brain infection, head trauma or hydrocephalus (excess
fluid on the brain)
progressive neuro-degenerative conditions
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.
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
![[Tsunami camp]](./images/tsunami_camp.jpg)
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.
![[School in Sri Lanka]](./images/sri_lanka_school.jpg)
![[School in Sri Lanka]](./images/children_with_toys.jpg)
![[School in Sri Lanka]](./images/sri_lanka_classroom.jpg)
![[School in Sri Lanka]](./images/boy_reading.jpg)