Table 1

Multiple system atrophy: diagnostic criteria

SND type (predominantly parkinsonism)		OPCA type (predominantly cerebellar)
Sporadic adult onset non or poorly levodopa responsive parkinsonism	Possible	Sporadic adult onset cerebellar syndrome with parkinsonism
Above,^1-150 plus severe symptomatic autonomic failure^1-152 or cerebellar signs or pyramidal signs or pathological sphincter EMG	Probable	Sporadic adult onset cerebellar syndrome^1-151 (with or without parkinsonism or pyramidal signs), plus severe symptomatic autonomic failure^1-152 or pathological sphincter EMG
Postmortem confirmed	Definite	Postmortem confirmed

↵1-150 Moderate or good, but often waning, response to levodopa may occur, in which case multiple atypical features need to be present.
↵1-151 Without DSM III-R dementia, generalised tendon areflexia, prominent supranuclear palsy for downgaze or other identifiable cause.
↵1-152 Postural syncope or marked urinary incontinence or retention not due to other causes.
Sporadic = no other case of MSA among first or second degree relatives. Adult onset = onset age ⩾30 y.
Modified from Quinn,¹⁵ with permission of the BMJ Publishing Group.