The inaugural Dr J B Peiris oration
Iconic Existence of Neurology in Sri Lanka

The orator, Dr Ranjani Gamage, then went on to describe the iconic existence of neurology in Sri Lanka.

The second Neurology unit in the country was established in Kandy in 1981 by Dr. Jagath Wijesekera. He served in Kandy until his appointment as the second neurologist to the National hospital of Sri Lanka. It was Dr. Jagath Wijesekara who having recognised that stroke was the second commonest cause of mortality in Sri Lanka, pioneered the stroke program in the country. Under his guidance a stroke unit was established in 1999 and a multi disciplinary stroke management team was formed. Upon his retirement in August 2004 the Stroke program was spearheaded by Dr Padma Gunaratne, Consultant Neurologist in charge of Neurology unit 2 at the NHSL. She too was an outstanding trainee of Dr Peiris and now contributes immensely towards the stroke programme in the country. The Administration of Thrombolytic therapy for acute strokes is one of the many new programmes she has launched. Currently she is the president of the Stroke Association of Sri Lanka.

With a view to expanding sub disciplines in Neurology, a department of Neurophysiology was established in 1999 in the Institute, with the support of Dr. Jagath Wijesekara and me. Dr Sudath Gunasekara was appointed as the first Consultant Neurophysiologist and pioneered Neurophysiological studies in the country. A training program for this new sub specialty of neurology was approved and drawn up when Dr Peiris was the executive Director of the Postgraduate Institute of Medicine.

The PGIM, University of Colombo commenced training of postgraduate students in 1982 and I was the first trainee to be board certified as a Neurologist from the Institute.

Struggling hard to follow in the footsteps of my trainer Dr Peiris, my vision was to improve the quality of services offered within the Institute and also to develop the sub disciplines in Neurology. Epilepsy attracted my attention since it was a common and a treatable condition and was responsible for severe social disability.

On my request a dynamic team of specialists banded together to form the Epilepsy Task Force. The goals of the Task Force were,

To establish a Tertiary care clinic for Epilepsy with a multidisciplinary approach, to launch and coordinate islandwide awareness programmes, to commence Epilepsy Surgery and to establish a state of the art Epilepsy Centre.

In 2002, the first ever Epilepsy Tertiary care clinic and programme commenced at the institute of Neurology, NHSL Currently we have evaluated more than 2000 patients under this program. Details of this advanced pre-surgical evaluation process will be presented to you during this scientific session, by a member of the Epilepsy Task Force.

The first epilepsy surgery was conducted by Dr. Sunil Perera, Consultant Neurosurgeon and his team at the NHSL in the year 2003. Since then the team had carried out over 200 surgeries with a success rate of 91% on 2-5 year follow up. The team is capable of evaluating and performing the full spectrum of surgeries that are done in the best centres in the world including intraoperative monitoring for complicated surgeries.

The Task Force was instrumental in the declaration of a National Epilepsy Day and conducting numerous Epilepsy Awareness Programmes’ islandwide. The team was also actively involved in formulating the National Guidelines for the management of Epilepsy.

Soliciting funds for the Epilepsy Centre was the biggest challenge I had ever faced in my life. It was really a snail paced heart wrenching trudge. After five years of hard work I managed to obtain a colossal sum of 20 million US $ for the project from a foreign source.

My vision is to establish a state of the art, fully equipped and fully functional, Epilepsy Centre, which will help to alleviate the enormous suffering of the epilepsy patients in Sri Lanka.

Having met the targets, the Epilepsy Task Force is in the process of transforming into a new organization namely The League against Epilepsy which would act as the Sri Lankan chapter of the ILAE. Already this organization, with the help of the ILAE had collaborated two workshops one on EEG and the other on Paediatric Epilepsy.

Once the Epilepsy care program was up and running we embarked on commencing a Movement Disorder Clinic which is offering services to many patients with Parkinson Disease. A surgical program was conducted with public and private sector cooperation due to the technologically advanced nature of the surgery requiring advanced computerised systems such as micro electrode recordings and neuro navigation equipment. To date we have carried out 7 Deep Brain Stimulation surgeries on Parkinson’s patients. All except one patient showed significant improvements in their disability.

Ladies’ and gentlemen, in retrospect, we at the Institute of Neurology are happy with what we have accomplished in two of the most technologically advanced fields in Neurology despite the many constraints and limitations.

Several other clinics are run by the Institute of Neurology under my guidance, in collaboration with the relevant experts. The Neurogenetics clinic and the Neuroinfections clinic are at their infancy and the Neuromuscular and Neuro ophthalmology clinics are still at their embryonic stages.

All teaching hospitals affiliated to Universities such as Colombo, Kandy, Galle, Kurunegala and Jaffna are manned by Neurologists. All these units cater for non-selected neurological admissions including emergencies. Now most units have separate male and female wards with limited bed strength. MRI imaging facilities are available in Colombo, Kandy and Galle. Most other provincial hospitals are also manned by neurologists. Majority of the units also have access to Neurophysiological and Neuroimaging facilities. In general they have adequate CT and woefully inadequate MRI scanning quotas.

At this juncture I must make special mention of Prof. Saman Gunatillake, President of the ASN and an exemplary trainee of Dr. Peiris. He is currently the Professor of Medicine, University of Sri Jayawardenepura, Sri Lanka.

Much has been contributed to the iconic existence of Neurology in Sri Lanka by Prof. Nimal Senanayake, Professor of Medicine, University of Peradeniya, Sri Lanka; He has a very special interest in Neurology and has contributed much to the field of Neurology by way of research. He is world renowned for his original papers.

Paediatric neurology was the most recent sub-discipline recognized in the country. We are extremely proud of the work carried out by the 2 board certified paediatric neurologists, at the LRH, the premier children hospital in the country.

Neurosurgical services are complimentary to the development and sustenance of neurological services of a country. We are extremely grateful to all the neurosurgical services available in the country including neuro-navigational facilities available in the private sector. A state of the art neuro-trauma centre is currently under construction at the National hospital of Sri Lanka, which will not only be an asset to the country but also to the region. Once operational it has the potential to be the best neuro-trauma centre in Asia.

Ladies and Gentleman it is evident that we have now reached a fitting climax to the work begun by Dr Peiris and the Institute of Neurology. Thus Dr. Peiris’s dream of improving neurological services in the country has grown from strength to strength. He will always be remembered for his yeoman service in the field of neurology.

Indeed he is the "Father of Neurology" in Sri Lanka; I would like to end this tribute in the words of Albert Pike,

"What we have done for ourselves alone, dies with us, what we have done for others and the world remains and are immortal"

The impressive function, enjoyed by all present, culminated with a colourful cultural pageant which included a Bharata Natyam dance by the female medical students of the Sri Jayawardenepura University.

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