Published in the May/June edition of Roseman University’s print edition of spectRum magazine.
By Vanessa Maniago
Eric Farbman, M.D. grew up in New Jersey as the oldest of three and the son of an engineer father, and homemaker and social worker mother. He received his Bachelor of Science and Master of Science degrees from Tufts University and while deciding if his path was leaning towards a Doctor of Philosophy (PhD) to conduct research, or a Doctor of Medicine (MD) to treat patients, an old friend encouraged Dr. Farbman to overnight his application (on the last day of the late period) to take the Medical College Admissions Test (MCAT). That advice helped catalyze his decision-making process and set him on his path in medicine. He went on to receive his MD from Rutgers University Medical School.
Medical school curriculum was difficult, but once exposed to clinical experiences, Dr. Farbman began to feel more optimistic about his decision to attend medical school. He enjoyed the neuroscience and neuropathology courses, which led to his future sub-specialty in neurology. Following a four-year residency, Farbman went on to complete a Movement Disorders Fellowship, all through University of Pittsburgh. Dr. Farbman found Pittsburgh to be the ideal place for residency training and to enjoy a favorite pastime, baseball, on the river at PNC Park – which he describes as a beautiful and accessible baseball stadium.
In 2006, following a year of work in Pittsburgh, Dr. Farbman moved to Las Vegas to join the practice of Dr. Steven Glyman and Dr. David Ginsburg. Eventually the UNSOM/UNLV Neurology department subsumed the practice and Dr. Farbman moved into academic medicine with ease, treating patients while helping to educate future students. Dr. Farbman and Dr. Ginsburg ultimately moved to Roseman University and see patients at the Roseman Medical Group practice located in the medical building adjacent to Spring Valley Hospital.
Dr. Farbman specializes in Movement Disorders, a class of neurological diseases that include Parkinson’s, Huntington’s, dystonia, ataxias and tremors. With Parkinson’s Disease, Farbman likens the diagnostic and evaluation of patients as putting together the pieces of a puzzle, a puzzle he enjoys solving. Parkinson’s patients might experience a fall, yet that symptom can be related to several other diseases. Ruling out other diseases helps ultimately form the diagnosis, along with presentation of some specific symptoms common to the disease.
According to the American Academy of Physical Medicine and Rehabilitation, Parkinson’s Disease is a progressive movement disorder resulting from the loss of nerve cells in the brain that produce a substance called dopamine. The cause of Parkinson’s Disease is unknown. One in every 800 individuals develops the condition, which is more common in men than in women. Parkinson’s Disease increases with age, with 90% of patients above 45 years of age, and may be related to genetic mutations. Exercise throughout adulthood may reduce a person’s risk.
Early symptoms of Parkinson’s Disease begin on one side of the body, with diminished fine motor control, or reduced foot or arm movement. Other symptoms include tremors, stiffness, posture imbalance, difficulty swallowing, constipation and urinary incontinence. Patients may experience slower movement and speech, fatigue, forgetfulness, loss of smell, and sleep disorders. Symptoms of late-stage Parkinson’s Disease include an expressionless face, soft voice and stooped posture, and an inability to walk.
Healthcare providers conduct thorough physical exams, noting specific signs and symptoms that are seen in Parkinson’s Disease. Diagnostic testing may play a role in evaluating the disease. Sleep studies, swallowing studies and psychological testing also can assess the severity of the condition.
Interestingly, those diagnosed with Parkinson’s have the highest risk of accompanying depression by age. Often, patients can’t sleep and potentially don’t generate adequate levels of dopamine or serotonin. As such, many Parkinson’s patients also take anti-depressants which can improve mood and movement issues. Doctors suspect there is a link between Parkinson’s and environmental pollutants, yet Dr. Farbman points out that Parkinson’s existed before the Industrial Revolution before there were factories and pollutant by-products of industry.
Of all the diseases Farbman treats, Parkinson’s is one closest to his heart. “Given its prevalence, its impact, how it can affect patients in multiple ways, Parkinson’s is both more prevalent and less deadly than Huntington’s. I estimate that in Southern Nevada there are roughly 15,000 people living with Parkinson’s Disease right now.” Many may be living with symptoms but have gone undiagnosed, especially among those under 40 with early-onset disease who may not consider Parkinson’s a disease that could even impact them.
Several medications are available to manage symptoms, such as tremors and stiffness, in the condition’s early stages. Balance training, stretching and strengthening exercises, and aerobic activity are utilized to help to maintain a patient’s function. Speech therapy is also often recommended. Deep brain stimulation, (DBS) which is a surgical procedure, also may relieve symptoms. Dr. Farbman specializes in this modality, which through an embedded device and neurostimulator, deep brain stimulation is delivered to patients to improve their symptoms. Dr. Farbman is currently managing 200 patients with this therapy. There is now a Levodopa pump that can be prescribed for Parkinson’s patients as well.
According to Dr. Farbman, about 1% of the population will experience Parkinson’s and 2% of those over 65 will experience it. He also notes that given the multitude of treatment options, there are far worse diagnoses than a Parkinson’s diagnosis. In its advanced stages, quality of life still can be good – more so life with limitations, not restrictions.
Dr. Farbman is very interested in clinical research around Parkinson’s and says, “Fortunately, this is an exciting time to be treating Parkinson’s Disease.” In addition to the recent FDA-approval of many new Parkinson’s treatments, there are many clinical research trials ongoing. Roseman University is a site for both the Parkinson Study Group and the Huntington Study Group with studies for patients with many different degrees of the disease, from newly diagnosed to advanced. A new study will soon start on multiple system atrophy, an atypical Parkinson-plus disorder with no current treatments, as well as an essential tremor study. Farbman is hopeful that there will be some new Huntington’s research studies soon as well.
Dr. Farbman is a gentle, affable, kind person with a natural gift for teaching and explanation. With his patients, he is patient and informative, delivering complex information in an approachable way. Active among the multiple support groups around the Valley, Dr. Farbman is truly a beacon of hope and telegraphs his optimism to his patients.
For patients wishing to learn more about Parkinson’s, Huntington’s, or other movement disorders, or to make an appointment to see Dr. Farbman, please call the Roseman Medical Group, the medical practice of Roseman University’s College of Medicine at 702-463-4040. For most, a diagnosis can feel like an interminable journey of the unknown. Dr. Farbman uses his experience, intellect, talents and gifts to give patients information, support, and hope in navigating Parkinson’s and other Movement Disorders.