by establishing large international biomarker cohorts is another priority. 5 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 has been identified, and a revision is planned. 6 Levin and colleagues' study showed that these un resolved issues could be crucial hurdles on the way to identification of a neuroprotective treatment for multiple system atrophy. Despite the positive aspects and gains of their trial, an efficacious treatment for patients with this devastating disease is still not available.