Table 1.

Current consensus criteria for the diagnosis of Multiple System Atrophy (MSA), according to Gilman et al. 2008.¹

Definite MSA	Autopsy-confirmed case with neuropathologic evidence of widespread and abundant CNS α-synuclein–positive glial cytoplasmic inclusions in association with striatonigral and/or olivopontocerebellar neurodegeneration
Probable MSA	Sporadic, progressive, adult (>30 years) -onset disease characterized by Autonomic failure involving Urinary incontinence (with erectile dysfunction in males); OR Orthostatic blood pressure drop of at least 30 points systolic or 15 points diastolic within 3 minutes after standing from a recumbent position AND one of the following predominant motor features Poorly levodopa-responsive parkinsonism (defined as bradykinesia with rigidity, tremor, or postural instability); OR A cerebellar syndrome consisting of gait ataxia with cerebellar dysarthria, limb ataxia, or cerebellar oculomotor dysfunction
Possible MSA	Sporadic, progressive, adult (>30 years) -onset disease characterized by Parkinsonism (defined as bradykinesia with rigidity, tremor, or postural instability); OR A cerebellar syndrome consisting of gait ataxia with cerebellar dysarthria, limb ataxia, or cerebellar oculomotor dysfunction AND at least one of the following symptoms that suggest autonomic dysfunction including Urinary urgency Urinary frequency or incomplete bladder emptying Erectile dysfunction in males Significant orthostatic blood pressure drop not meeting the criterion for Probable MSA AND at least one of the following additional features for MSA-P or MSA-C MSA-P or MSA-C Babinski sign with hyperreflexia Stridor MSA-P Rapidly progressive parkinsonism Poor response to levodopa Postural instability within 3 years of motor onset Gait ataxia, cerebellar dysarthria, limb ataxia, or cerebellar oculomotor dysfunction Dysphagia within 5 years of motor onset Atrophy on MRI of putamen, middle cerebellar pedunle, pons, or cerebellum Hypometabolism on FDG-PET in putamen, brainstem, or cerebellum MSA-C Parkinsonism (bradykinesia and rigidity) Atrophy on MRI of putamen, middle cerebellar peduncle, or pons Hypometabolism on FDG-PET in putamen Presynaptic nigrostriatal dopaminergic denervation on SPECT or PET