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As of 2018 Multiple System Atrophy is diagnosed based on clinical observation of symptoms. There is no biomarker yet available to give a diagnosis with 100% certainty. Post mortem brain autopsy is the only way for the family to know the definite diagnosis. Brain autopsy arrangements should be done in advance. There are defined diagnostic criteria for possible and probable MSA available at this link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2676993/ Many doctors are not aware of these criteria so patients are encouraged to share this information.