Spotlight on Linn Katus, DO, MSc

Linn Katus, DO, MSc is a one of a few movement disorders neurologists in the country who specializes in cerebral palsy. In this spotlight interview, Dr. Katus shares with us her work in improving identification and treatment of dystonia in cerebral palsy.

1) How did you get started in specializing in movement disorders?

I became interested in movement disorders before I went to medical school while I was working at the NIH. I was working in a neuro-immunology lab, and a mentor recognized my interest in the physical exam of patients. He suggested that I sit in on movement disorder rounds, where the movement disorder neurologists in another group discussed their cases. I did and I was hooked, completely fascinated by how much information we can get from talking to and examining a patient. After this my interest persisted and I pursued a neurology residency after medical school and then a movement disorder fellowship after that.

2) Dystonia is a frequently an overlooked element of CP. What can patients and caregivers look out for and how can they raise this with their physicians?

Dystonia is when there are extra involuntary muscles contractions that get worse when patients are engaged in conversation, have heightened emotions, and/or activate other voluntary movements. These movements can happen at rest but are usually less, and they go away in sleep. 

If patients and caregivers notice extra movements that come out in certain situations and interfere with any activities, they should bring it up with their doctors. We have various treatment options to help with dystonia, but sometimes just knowing what it is can be a helpful. If dystonia is not bothersome and doesn’t interfere in any activities, it does not need to be treated.

If your doctor is not sure if you have dystonia or does not know what dystonia is, ask about a referral to a movement disorder neurologist. 

3) How do you assess dystonia in your CP patients?

When I first meet a patient with CP, I do a full intake of their past history and prior treatments, as well as discuss what their current issues are and what they would like help with. I also do a physical exam. During the history taking and exam I look for specific features of dystonia. If a patient does have dystonia, I want to get a good sense of how it impacts their life and if treatment would be helpful for them.

4) You have a focal treatment for dystonia using Botulinum toxin injections. Can you share something about that?

Medications tend to be best for more generalized or multifocal dystonia. Botulinum toxin injections can be useful for focal dystonia. Botulinum toxin works by blocking the signal from the nerve telling the muscle to contract. It is dose dependent, meaning small doses block less signal and larger doses block more. The goal is to give enough medication in the correct muscle to block abnormal contraction, while still preserving strength and the ability to have voluntary contractions. This is a balance and not always perfect, with the ultimate goal of improving patient function and quality of life. Botulinum toxin only works in the area it is injected to, so there should be no systemic side effects.

Botulinum toxin usually has an effect for 12 weeks, though it can be less in some and more in others. Because of this, patients have to come back every 3-6 months for repeat injections to maintain benefit.

5) You are one of a few CP dystonia specialists in the country. Tell us about your work in this space outside of your clinical practice.

I have been working with other experts and the CPRN (Cerebral Palsy Research Network) to help improve the identification of dystonia in patients with cerebral palsy. Dystonia has been underrecognized and thus undertreated, and we hope to improve recognition and treatment to ultimately improve the quality of life of people with CP and dystonia. After improving identification of dystonia, our goal is to better understand and improve our treatment options.