Table 2.

Clinical features supporting and non-supporting a diagnosis of multiple system atrophy. Modified from [240].

Supporting clinical features (red flags)	Non-supporting features
• Orofacial dystonia	• Pill-rolling rest tremor
• Disproportionate antecollis	• Clinically significant neuropathy
• Camptocormia (severe anterior flexion of the spine) with or without Pisa syndrome	• Onset after age 75 years
• (severe lateral flexion of the spine)	• Family history of ataxia or parkinsonism
• Contractures of hands or feet	• Dementia (on DSM-V)
• Inspiratory sighs	• Hallucinations not induced by drugs
• Dysphonia	• Loss of smell
• Dysarthria
• New or increased snoring
• Cold hands and feet
• Pathological laughter or crying
• Jerky, myoclonic postural or action tremor