MotIoN aDaptive Deep Brain Stimulation for MSA

Inclusion Criteria: * Diagnosis of MSA with disabling autonomic symptoms * \>6/12 in the autonomic subsection (Q9-12) of the UMSAR scale * Patient willing and able to give informed consent to involvement in the study. * Male or female aged 55 years or over * Able to walk (to perform gait analysis) * Have an anticipated prognosis \> 2 years Exclusion Criteria: * Female of child-bearing age * The patient is unwilling to participate or unable to give informed consent. * The patient has been deemed unfit for stimulator insertion by their healthcare team i.e. surgical contraindications to DBS: * Bleeding or coagulation disorder * Not fit for general anaesthetic * Unable to deal with implanted DBS system (turn on and off and recharging where applicable, although it is acceptable if a carer can do this) * Untreated anxiety or depression * Unable to undergo preoperative MRI (e.g. metal implants) * Subject is currently participating in a clinical investigation that includes an active treatment arm.