Table 5

Provides a list of possible MSA mimics and when to consider them

MSA mimicsConsider if…
Parkinson’s diseaseSignificant and sustained response to L-dopa (>30% improvement in UPDRS-III), anosmia, delayed onset of autonomic symptoms
Dementia with Lewy bodies60 Fluctuating consciousness and cognitive change with hallucination (particularly visual), not secondary to L-dopa treatment
Progressive supranuclear palsy63 Vertical saccade slowing, supranuclear gaze palsy
Frontalis overactivity and retropulsion
Frontal cognitive change, non-fluent variant primary progressive aphasia
Corticobasal degeneration64 Asymmetrical limb dystonia, alien limb
Vascular Parkinsonism65 Onset >75 years, vascular risk factors, dementia
Normal pressure hydrocephalusCognitive impairment, lack of upper limb signs
Neurogenetic conditions
Spinocerebellar ataxia types 1,2,3,6,7,12,1766 May have a positive family history, but deterioration likely slow
CANVAS67 Chronic dry cough, positive head impulse test, peripheral neuropathy
C9ORF72 expansion68 Positive family history, lower motor neurone signs (eg, fasciculation, wasting)
Friedreich’s ataxia66 Peripheral neuropathy, pes cavus, loss of lower limb reflexes cardiomyopathy, type two diabetes mellitus
Fragile X tremor–ataxia syndrome66 X-linked inheritance, peripheral neuropathy, behavioural disorders with executive dysfunction
  • CANVAS, cerebellar ataxia, neuropathy, vestibular areflexia syndrome; MSA, multiple system atrophy; UPDRS-III, Unified Parkinson’s Disease Rating Scale part III.