Neuroscience Articles from Ochsner Health Experts

Explain More, Cut Less: Dr. Seth Hayes Approach to Neurosurgical Care on Louisiana's Northshore

My (Seth Hayes, MD) deep affinity for the field began nearly 20 years ago when, as a medical student, I first saw the positive impact spine and brain surgery can have on patients’ lives. Neurosurgery is so vast and comprehensive. As neurosurgeons we learn everything from interventional radiology and neuroradiology to radiation oncology—not to mention the technical skills we master. 

At Ochsner Health Center, my team and I routinely utilize today’s most sophisticated robotic systems and minimally invasive surgical techniques to achieve the best possible outcomes for our patients with fewer complications and less recovery time. 

It is truly a wondrous time to practice Neurosurgery. 

My Patients are My Practice 

There is, however, one aspect of neurosurgical care that does not sit right with me—and never will. 

It is when patients come to see me for the first time—as referrals or seeking a second opinion—and lack a fundamental understanding of their condition and the reasons why they previously underwent procedures. 

When I educate these patients, many respond with words of gratitude that both break my heart and inspire me: “Thank you. No one ever explained this tome before.” 

Patient education is a central pillar of my practice. I spend a great deal of quality time explaining conditions to patients, walking them through treatment options, and listening attentively to their questions and concerns. Patients deserve honesty and understanding. 

This is personal for me. I practice on Louisiana’s Northshore—treating patients from St. Tammany Parish to Tangipahoa Parish and beyond—a community where I have deep roots. My grandparents hail from the Northshore, my family and I live here, and my children attend school here. Many of the local folks I know—neighbors, friends, and colleagues—are also my patients. 

That lends a deeper meaning to everything I do. 

We Treat Most Conditions Nonsurgically 

My team and I most commonly treat degenerative spine pathologies such as spinal stenosis, herniated disks, neck pain, and back pain. 

Brain conditions we frequently treat include intracranial hemorrhages, subdural hematomas, and tumors. 

Many patients and referring physicians are surprised to learn that we manage conditions nonsurgically 70% - 80% of the time in our outpatient clinic. 

Our goal is always to accurately assess the severity of a patient’s condition and select the least invasive solution for them. That may mean simply reassuring and observing the patient, referring them for physical therapy (PT) or injections, and sometimes recommending surgical interventions. 

Even when surgery is appropriate, we ask ourselves: “Can we do less?”

Minimally Invasive Surgery is like Building Ships in Bottles 

Advancements in minimally invasive spine techniques and technologies continue to change the game in neurosurgery. 

Today, using a combination of tubular retractors as small as 16-22 mm, microscopes, high-resolution cameras, and advanced navigation systems, my team and I can access pathology in ways impossible with the naked eye. When explaining minimally invasive surgery to patients, I liken it to building a ship in a bottle. We construct support structures in extremely tight spaces with incredible precision. 

But I also make sure patients understand there is nothing “gimmicky” about these sophisticated surgical techniques. The benefits are real and include lower infection rates, much less blood loss, fewer complications, and far less collateral damage to healthy tissue. 

Spinal techniques we perform include tubular microdiscectomy or laminectomy. We pursue the same goal with these minimally invasive procedures as with traditional open lumbar decompression—but through a tiny one-inch incision and small port. 

Other minimally invasive procedures we offer include transforaminal lumbar interbody fusions (TLIFs) and extreme lateral interbody fusions (XLIFs). Using these techniques, we can remove and reconstruct damaged discs and vertebrae. 

The robotic and navigation systems we use provide GPS-level precision, allowing us to see exactly where we are operating within the body during complex reconstructions. 

An Integrated Culture of Multidisciplinary Collaboration 

Collaboration is the backbone of care within my practice and at Ochsner Health as a whole. We have built a deeply interconnected network of multidisciplinary experts that include: 

• Brain and spine surgeons
• Interventional pain management specialists
• Imaging clinicians
• PT specialists
• Advanced practice providers (APPs) 

Our system supports a high level of integration. Because the majority of cases we handle are nonsurgical, I often order procedures like epidural steroid injections myself. Radiology, orthopedic, and PT teams within Ochsner Health all share one medical record and communicate freely and frequently. 

This open, unified system keeps patients from getting lost during transitions between treatment teams and care settings. 

I work very closely with my surgical partners. We regularly turn to one another for second or third opinions. Each of us brings something different to the table, which allows us to offer comprehensive and more specialized care locally. 

Within our clinic, we have invested a lot of time and energy into building a collaborative culture that always aims to bring patients the best benefits. 

Partnership with St. Tammany Parish Hospital 

We have a long-standing partnership with St. Tammany Parish Hospital, serving as their primary brain and spine care providers. Over the years, we have expanded far beyond neurosurgery, building a dedicated intensive neurocritical care unit staffed by neurointensivists. The unit includes brain-and spine-specific inpatient floors where patients receive expert care from specially trained nurses. 

In our OR, we deploy a unique “neuro team” of scrub technologists, fluoroscopy technologists, and other surgical and neurodiagnostic specialists, all dedicated to neurosurgery 24/7. 

From pre-op through the OR and post-op—as well as across nonsurgical care—we have built highly skilled and specialized teams. 

My Message to Referring Providers 

Our referral base includes not only the roughly 250,000 people living in the Northshore, but also extends well across the region. 

We have constructed a system that makes communication with referring providers smooth and easy. There are multiple referral avenues available through which providers can access me, my partners, and our fantastic team of nurses, medical assistants, and APPs. 

In addition to delivering high-quality surgical and nonsurgical care, my team and I practice deep empathy and honesty with patients. We always put ourselves in the patient’s shoes, understanding challenges from their perspective during one of the most vulnerable times in their lives. We communicate openly, making sure patients understand their treatment options and engaging in shared decisions with them about how to proceed with care. 

How to Refer

To contact Ochsner Neurosurgery-Covington about a patient referral, or to learn more about our Neurosurgery offerings, click here.

At Ochsner Health’s New Neuroscience Center, Collaboration Drives Care of Complex Neurologic Cases

“When you’re trying to solve a neurological mystery, the story matters,” says Kristina Lafaye, MD, a board-certified neurologist practicing at Ochsner Health’s new Neuroscience Center in New Orleans. “Talking to patients and learning their history helps uncover the narrative behind the seemingly undiagnosable cases we often see here at Ochsner’s main campus.”

Dr. Lafaye is no stranger to the practice of attentive listening and therapeutic communication. She holds a master’s degree in psychology and recognizes how intertwined the two disciplines are. “I listen to patients every day, just like in psychology. The difference now is that I get to do something about it as a neurologist, by intervening to solve their chief complaint.”

A specialist in electromyography (EMG), nerve conduction studies, and second-opinion consultations, Dr. Lafaye helps diagnose and manage a broad range of neuromuscular conditions, including:

• Amyotrophic lateral sclerosis (ALS) and other motor neuron disorders at Ochsner’s nationally recognized ALS Center of Excellence
• Peripheral neuropathy, including immune-mediated cases and those related to other systemic conditions
• Myasthenia gravis and other neuromuscular disorders
• Inflammatory myopathies and genetic muscular dystrophies
• Trigeminal neuralgia and nerve-related pain syndromes

“There’s something deeply satisfying about finally giving a patient a definitive diagnosis—naming the beast, as it were,” said Dr. Lafaye. “It’s a powerful moment of clarity for patients, providing validation that their symptoms are real and can be treated.”

State-of-the-art diagnostics

There is a strong culture of collaboration within the Neuromuscular Program at Ochsner Health. Dr. Lafaye works closely with her colleagues to evaluate complex patient cases and arrive at differential diagnoses.
Recently, she worked with a colleague who performed single-fiber EMG on a treatment-refractory patient who had been diagnosed with myasthenia gravis. The single-fiber EMG revealed that the patient was not suffering from a neuromuscular disorder, allowing the team to discontinue ineffective treatment and redirect care appropriately.

Ochsner recently opened a new Autonomics Lab, the only one of its kind in Louisiana, offering specialized diagnostic testing for complex neuromuscular conditions. “This is a major enhancement for the diagnosis of dysautonomia and related autonomic disorders,” said Dr. Lafaye. “The ability to confirm these complex diagnoses through specialized testing has already improved our precision in treating patients.”

Dr. Lafaye and the team also perform targeted biopsies when indicated. Muscle biopsies have largely been replaced by less invasive options such as skin biopsies to evaluate for small fiber neuropathy.

Trust is a must

Getting to know patients and talking to them openly are vital to determining the best course of care. “There’s rarely just one ‘right’ treatment for a given condition,” said Dr. Lafaye. “More often, there’s a menu of reasonable options, each with its own benefits and drawbacks. My job is to help patients understand the trade-offs and decide what best fits their needs and circumstances.”

In patients with myasthenia gravis, for example, oral medications are often a convenient option. But it can take time for them to be effective, which is not always ideal. In those cases, Dr. Lafaye offers alternative therapies that act more quickly, ensuring her patients understand side effects that may accompany these options, like short-term weight gain. 

Certain treatments may be contraindicated because of patient comorbidities such as diabetes or osteopenia. Others, like infusions or injections, require travel to an infusion center—or arranging for home administration—which may not be viable for some patients. Engaging deeply with patients to understand their circumstances and preferences helps determine the best course.

In some instances, patients are overwhelmed by the number of medicines they’ve been prescribed. Dr. Lafaye is a strong believer in de-prescribing, or simplifying medication regimens, under certain circumstances to enhance patients’ well-being and improve their quality of life. 

Important insights often emerge from open, honest, and even difficult conversations. “Sometimes, supplements or alternative therapies patients have chosen are contributing to their symptoms,” said Dr. Lafaye. “For example, excessive intake of vitamin B6 can cause neuropathy, which we can confirm with a simple blood test. I’ve also seen cases where deficiencies in vitamin B12 or copper—sometimes related to illicit substance use—can lead to severe neuropathy or myelopathy.”

Dr. Lafaye welcomes these discussions with patients. She also appreciates patients who want to incorporate nutrition, exercise, and lifestyle modifications into their neurologic care, as she is an advocate of integrative approaches.

A transformative time in neurologic care

Dr. Lafaye cites the evolution of genetic diagnostics as one of the biggest game changers in neurology today. Genetic testing can accurately identify underlying causes of neuromuscular disorders, often eliminating the need for invasive procedures once considered standard.

“Our genetics department here is outstanding,” Dr. Lafaye said. “I’ve had several so-called ‘mystery’ patients finally receive a definitive diagnosis after years of uncertainty because we pinpointed a specific gene mutation.”

That powerful genetic clarity also helps guide treatment and individualize patient care in ways never before possible. Advances in biologic and immune-modulating therapies allow the team to effectively manage conditions once considered untreatable, such as spinal muscular atrophy. Today’s disease-modifying treatments are significantly changing the trajectories of patients’ lives at Ochsner. Emerging genetic therapies in other areas of neurology, like the treatment of Huntington’s disease, are likewise beginning to transform outcomes.

“It is an incredibly promising time for patients and the field as a whole,” said Dr. Lafaye.

A strong spirit of collaboration

Ochsner’s Neuromuscular Program offers comprehensive, coordinated care under one roof at its new Neuroscience Center. A broad range of subspecialists in neurology collaborate to provide patients seamless access to the services they need.“There’s nothing like being surrounded by colleagues you can consult with on the spot,” said Dr. Lafaye. “A lot of our collaboration happens informally in offices, hallways, or over our secure chat system which allows instant communication across specialties. There’s a real culture of openness here, an exchange of ideas that makes us better and enhances patient care.”

That strong spirit of collaboration extends to referring providers as well. Dr. Lafaye and the neuromuscular team routinely perform advanced diagnostic evaluations of patients, going beyond the initial workups referring providers have already done by performing specialized testing to determine why patients are experiencing certain symptoms.

Advanced evaluations include detailed electrodiagnostic studies, specialized imaging, and targeted neurological exams. The goal is always to gain the deeper insights necessary to guide treatment appropriately. 

Throughout diagnosis and treatment, Dr. Lafaye maintains open communication with referring providers and is always available to answer questions and discuss details. “When working with us, referring providers can expect a careful, thoughtful, and collaborative approach aimed at uncovering a patient’s underlying condition, treating it effectively, and improving their quality of life,” she said.

Amazing ALS patients

Dr. Lafaye finds herself continually inspired by all her patients—especially those in Ochsner’s ALS clinic. Despite the devastating nature of their diagnosis, ALS patients are among the most engaged and positive individuals she treats.

“Even those patients who can no longer speak or move independently, remain active participants in their care,” said Dr. Lafaye. “They’re researching new trials, discussing diet and supplements, connecting with support groups. One patient even decided to homeschool his two children after being diagnosed, so he could spend more of his time with them.”

For ALS patients, hope and quality of life are not solely defined by prognosis. The collaborative, multidisciplinary approach from neurologists, palliative medicine specialists, nutritionists, respiratory therapists, physical and occupational therapists, and mental health professionals make an enormous difference. Though treatments for ALS remain limited today, the integrated care model at Ochsner is helping improve patients’ comfort, function, and longevity.

“I think that’s the greatest lesson from the ALS clinic,” Dr. Lafaye said. “Even in the face of a challenging diagnosis, patients can live with tremendous dignity, strength, and hope. It’s humbling and reminds all of us why we do this work.”

Revolutionizing Alzheimer’s Care at Ochsner Health

The diagnostic and therapeutic landscape of Alzheimer’s disease is shifting rapidly, with new technologies offering earlier detection and more targeted treatment than ever before. At the center of this evolution is James Fraser Rini, MD a board-certified behavioral neurologist at Ochsner Health.

Dr. Rini earned his MD and MPH from New York Medical College in 2015, completed his residency at the University of South Alabama, and then a fellowship in Behavioral Neurology at the UCSF Memory and Aging Center. Since joining Ochsner in 2021, his work has focused on improving accessibility, affordability, and equity in behavioral neurology through the use of personalized digital tools and next-generation diagnostics. His research includes the use of embodied virtual reality to enhance remote screening for neurodegenerative conditions—technology that may redefine how and where patients receive care.

A Clinical Q&A with James Fraser Rini, MD

Q: What is the clinical significance of the new blood test for Alzheimer’s disease?
A: The emergence of blood-based biomarkers is a major step forward in making Alzheimer’s diagnosis earlier, less invasive, and more accessible. These tests detect abnormal proteins in the blood—previously only measurable via PET scans or spinal fluid—allowing us to identify Alzheimer’s pathology years before symptoms become severe. This opens the door to earlier intervention, better prognostication, and more personalized treatment plans.

Q: How does this test compare to existing diagnostic methods in terms of accuracy and utility?
A: While PET imaging and CSF analysis remain gold standards, blood-based tests have shown strong correlation with these methods. Their major advantage is accessibility. They can be used earlier in the diagnostic process, which helps clinicians identify who should proceed with more advanced testing or begin therapeutic discussions.

Q: How might blood-based biomarkers change the diagnostic workflow for Alzheimer’s in primary and specialty care?
A: These tests are likely to become a first-line tool in evaluating at-risk patients. In primary care, they enable early identification and referral. In specialty settings, they help prioritize advanced imaging or lumbar punctures, streamlining care and accelerating access to treatments.

Q: Ochsner Health is a high-volume referrer for anti-amyloid therapy. Do you anticipate this trend will continue?
A: Yes. As we improve our ability to screen patients and predict risk for treatment-related complications, these therapies will become safer and more widely accepted. This will lead to greater confidence among patients and providers, and broaden the role of anti-amyloid agents in standard care.

Q: How do you see anti-amyloid therapy evolving in the broader context of Alzheimer’s treatment?
A: Anti-amyloid therapy is just one piece of a precision medicine strategy. Future care will involve multimodal approaches that also target tau, neuroinflammation, vascular health, and synaptic function. The goal is to build individualized treatment plans based on each patient’s biomarker profile—addressing Alzheimer’s from multiple biological angles.

Q: What have you learned from being part of a high-volume referral center for anti-amyloid therapy?
A: The most important lesson is that successful treatment isn’t just about the drug—it’s about the system. You need a coordinated team: neurologists, radiologists, infusion nurses, patient navigators. Within a supportive infrastructure, we can ensure safe administration, timely monitoring, and integration into the patient’s overall care network.

Q: How should clinicians approach patients with a family history of Alzheimer’s or related dementias?
A: A positive family history should prompt early and open communication. It’s an opportunity to identify modifiable risk factors, encourage lifestyle changes, and consider baseline cognitive assessments. In some cases, biomarker testing can provide valuable guidance for long-term care planning.

Q: What are some misconceptions about Alzheimer’s that may impact physician decision-making or patient counseling?
A: One major misconception is that memory loss is a normal part of aging, which can delay diagnosis. Another is that early diagnosis doesn’t make a difference—when in fact, early detection enables interventions that can meaningfully affect disease trajectory and quality of life.

Q: What role do you see for primary care providers, especially now with access to more precise diagnostic tools?
A: Primary care providers are essential in early identification. They’re often the first to notice cognitive concerns. With blood-based biomarker testing, they can initiate the diagnostic process sooner, coordinate specialty referrals, and manage comorbidities that influence progression. Their role is central to integrated, community-based care.

Q: What developments in Alzheimer’s diagnosis, treatment, or management are most promising from a clinical perspective?
A: Three trends stand out: first, the availability of early and accessible diagnostic tools; second, improved risk prediction and monitoring for therapies; and third, the movement toward precision medicine. These developments allow us to personalize care more effectively, with safer, more targeted interventions supported by a coordinated care team.

Advancements in Alzheimer’s diagnostics and therapeutics are reshaping clinical practice. The integration of blood-based biomarkers, improved risk stratification, and precision-targeted therapies are enabling earlier, more individualized care. As Dr. Rini’s perspective illustrates, the future of Alzheimer’s management will depend not only on technological innovation but also on coordinated, multidisciplinary care models that bring these tools into everyday clinical workflows.

For More Information, a Second Option, or to Refer a Patient

• For more information on Ochsner’s Neurology Department and Programs, click here.
• If your patient needs a second opinion, call 504-842-3980.
• Ochsner Health takes great care in documenting and adhering to your specific preferences for receiving follow-up communication about the progress of your referred patients.
• To refer a patient, call the Clinic Concierge at 866-805-3872.

About Ochsner Health System and the Ochsner Neuroscience Institute

Ochsner Health is the leading nonprofit healthcare provider in the Gulf South, delivering expert care at its 46 hospitals and more than 370 health and urgent care centers. Ochsner Children’s has been recognized as the No. 1 hospital for kids in Louisiana for four consecutive years.

Ochsner inspires healthier lives and stronger communities through a combination of standard-setting expertise, quality and digital connectivity not found anywhere else in the region. In 2024, Ochsner Health cared for more than 1.6 million people from every state in the nation and 63 countries. Ochsner’s workforce includes more than 40,000 dedicated team members and over 4,900 employed and affiliated physicians.

The Ochsner Neuroscience Institute is dedicated to delivering exceptional care for every patient. With advanced facilities, highly specialized services and a team of committed experts, we support everything from minor concerns to complex neurological conditions. Our mission is to offer world-class care and ensure that medical information is clear and easy to understand, empowering you to make informed decisions about your health confidently.

Ochsner Health is proud to announce the future new Debra H. and Robert J. Patrick Neuroscience Institute. This 132,000-square-foot facility will soon be home to the nationally ranked Ochsner Neuroscience Institute, bringing 25 nationally renowned programs under one roof. This will be the only major neuroscience institute between Houston and Atlanta, serving as a catalyst for innovation in the field of neurosciences for the patients of the Gulf South.