Multiple system atrophy is unique amongst these disorders as it is characterized histologically by the accumulation of aggregated α-synuclein, primarily in oligodendroglia (glial cytoplasmic inclusions) rather than in neurons.2 Clinically, multiple system atrophy is characterized by Parkinsonism, ataxia, and severe autonomic dysfunction, and patients with its more aggressive course have a 45% chance of experiencing falls at least once a day and a 15% chance of unintelligible speech within 2 years of diagnosis.3 It may be preceded by rapid eye movement sleep behaviour disorder. The gene discussed is SNCA; the disease is REM sleep behavior disorder.