Multiple system atrophy (MSA) is a rare, sporadic and progressive neurodegenerative disease. Its clinical manifes- tations are different combinations of Parkinson's syndrome, cerebellar ataxia and autonomic dysfunction. Due to the complex pathogene- sis, rapid progression and limited response to drug treatment, there is an urgent clinical need to explore effective treatment methods. In recent years, invasive neuromodulation techniques such as deep brain stimulation (DBS), spinal cord stimulation (SCS) and sacral neuromodulation (SNM) have attracted extensive attention in the symptomatic management of MSA. This article systematically reviews the current application and efficacy of the three invasive neuromodulation techniques mentioned above in the treatment of MSA. Patho- logical changes of MSA at different neural targets and their impact on the selection of therapeutic targets are analyzed. Advantages and disadvantages are compared between invasive and non-invasive neuromodulation. It also looked ahead to future development prospects. Current evidence suggests that SCS shows potential in improving frozen gait, dysarthria and orthostatic hypotension and SNM provides temporary symptom relief for MSA-related lower urinary tract and bowel dysfunction although the efficacy of DBS in MSA is limited. However, current research is largely based on small-sample and non-controlled case reports. Large-scale, prospective and randomized controlled trials are urgently needed to further validate their efficacy and safety.