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.