Diagnostic Categories of Multiple System Atrophy

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I. Possible MSA: one criterion plus two features from seperate domains. When the criterion is Parkinsonism, a poor levodopa response qualifies as one feature (hence only one additional future is required).

II. Probable MSA: criterion for autonomic failure/urinary dysfunction, plus poor levodopa-responsive Parkinsonism or cerebellar dysfunction.

III. Definite MSA: pathologically confirmed by the presence of a high density of glial cytoplasmic inclusions in association with a combination of degenerative changes in the nigrostriatal and olivopontocelebeller pathways.

The features and criteria for each clinical domain are shown in Table 7.

(Reprinted with permission from Gilman S, Low PA, Quinn N, et al. Consensus statement on the diagnosis of multiple system atrophy. J Neurol Sci 1999;163:94-98.)

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