In a related editorial the author notes that the accuracy of early clinical diagnosis is still an issue, with a high frequency of misdiagnosis particularly in the early stages of disease. Clinical criteria that were last revised more than 10 years ago are still in use. The need to revise these criteria to enable accurate diagnosis early in the disease course are needed as these unresolved issues could be crucial hurdles on the way to identification of a neuroprotective treatment for multiple system atrophy.