To diagnose multiple system atrophy (MSA), a physician will begin by compiling a thorough medical history of the patient and performing a complete physical examination. The patient’s symptoms, their duration and severity will be discussed. A neurological examination also may be performed.

There are no specific tests that can definitively determine whether a patient has MSA. However, certain diagnostic tests may be performed in cases of suspected MSA. These include:

• Tilt-table test. A patient lies on a table that is gradually raised, while heart rate and blood pressure are monitored. This test can identify whether a patient experiences orthostatic hypotension. If a patient faints or temporarily loses consciousness during this test, it may indicate an illness affecting the autonomic nervous system (e.g., MSA, Parkinson’s disease, diabetes).
  
  
• Electromyography (EMG). A test in which needles are inserted into certain muscles to test the electrical activity the muscles generate. EMGs may be helpful in confirming motor nerve damage in patients with MSA.

Urine tests, blood tests and imaging tests such as magnetic resonance imaging (MRI) also can be helpful in diagnosing MSA.

MSA is extremely difficult to diagnose because its symptoms can be similar to other diseases (e.g., Parkinson’s disease, neuropathy, supranuclear palsy). In many cases, patients with MSA may be wrongfully diagnosed as having Parkinson’s disease. In order to differentiate between the two conditions, a physician may prescribe certain medications (e.g., levodopa) known to alleviate symptoms in patients with Parkinson’s disease, but not those with MSA. If a patient’s parkinsonism symptoms fail to respond to levodopa, it may suggest MSA. Also, imaging tests that identify damage in specific areas of the brain can suggest MSA rather than another condition.