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This article is from PLoS ONE , volume 9 . Abstract Background: New agents with neuroprotective or neuroregenerative potential might be explored in primary-progressive Multiple Sclerosis (PPMS) - the MS disease course with leading neurodegenerative pathology. Identification of patients with a high short-term risk for progression may minimize study duration and sample size. Cohort studies reported several variables as predictors of EDSS disability progression but findings were partially contradictory. Objective: To analyse the impact of published predictors on EDSS disease progression in a large cohort of PPMS patients. Methods: A systematic literature research was performed to identify predictors for disease progression in PPMS. Individual case data from the Sylvia Lawry Centre (SLC) and the Hamburg MS patient database (HAPIMS) was pooled for a retrospective validation of these predictors on the annualized EDSS change. Results: The systematic literature analysis revealed heterogeneous data from 3 prospective and 5 retrospective natural history cohort studies. Age at onset, gender, type of first symptoms and early EDSS changes were available for validation. Our pooled cohort of 597 PPMS patients (54% female) had a mean follow-up of 4.4 years and mean change of EDSS of 0.35 per year based on 2503 EDSS assessments. There was no significant association between the investigated variables and the EDSS-change. Conclusion: None of the analysed variables were predictive for the disease progression measured by the annualized EDSS change. Whether PPMS is still unpredictable or our results may be due to limitations of cohort assessments or selection of predictors cannot be answered. Large systematic prospective studies with new endpoints are needed.

St. Patrick's Breastplate - This prayer is attributed to St. Patrick and his disciples. It is written with some Celtic pagan elements, but is definitely a Christian prayer asking God for protection through daily life.<br><br>A Letter to the Soldiers of Coroticus - Patrick writes this letter to excommunicate the soldiers of Coroticus' army who pillaged villages in Ireland and forced many Christian converts into slavery.<br><br>Confession - A short autobiography by St. Patrick who tells of being abducted into slavery and taken to Ireland, the growth of his faith, his ministry as a bishop in ordaining many priests and baptising thousands of people, and a trial where he had to defend himself against his accusers.