Gottwald W
Fortschr Neurol Psychiatr Grenzgeb. 1977 Jun;45(6):335-48.
Lupus erythematodes is related to the vegetative nervous system in Raynaud's disease, the butterfly distribution in the face, the involvement of the lateral part of the eyebrows (Hertoghe) and in cerebral attacks. Involvement of peripheral and central animal nervous systems is common and produces primary and secondary syndromes. Prominent are polymyositis or lupus-myopathy, in the brain mainly functional psychoses, epileptiform attacks, and a variety of focal, often very massive, signs. There are very clear differences from the neurologic signs of dermatomyositis, less so from arteritis nodosa and even less from progressive sclerodermia. Peripheral neurologic syndromes in lupus erythematosus are less common and more subtle than in arteritis nodosa. Bio-electric parameters of the petitmal-trias have been found. The relative absence of collagenoses from the spinal cord is also noticed in lupus erythematosus. Signs of involvement here appear to be limited and often subacute. Differential diagnosis has to consider many neurologic diseases, a special problem when MS is simulated just as in sclerodermia. Since cerbral attacks appear early in about 5%, the use of anticonvulsive drugs, particularly of the hydantoin group, provides special problems. Signs of myasthenia demand further attention. The neuropathologic changes are known in essential points and can obviously hardly be mistaken for inflammatory processes due to other causes. Certain basic facts appear to apply to other collagenoses. All 4 "grand" or "classic" collagen diseases are very similar and have much in common, but also show more or less definite differences. This is true for their clinical and anatomical appearance and last but not least to their neurologic aspects. The "roof-concept" of Collagenosis" is once more proved to be justified. As far as is known today the autonomic system plays a decisive and obligatory role only is sclerodermia. This syndrome is also the only one which contains the odd phenomenon of atrophy of which the best-known form is facial hemia-atrophy.
红斑狼疮与雷诺氏病中的植物神经系统、面部的蝶形分布、眉外侧部（赫托格征）受累以及脑部发作有关。外周和中枢动物神经系统受累很常见，并产生原发性和继发性综合征。突出的表现有多发性肌炎或狼疮性肌病，在脑部主要是功能性精神病、癫痫样发作以及各种局灶性、通常非常严重的体征。与皮肌炎的神经体征有非常明显的差异，与结节性动脉炎的差异较小，与进行性硬皮病的差异更小。红斑狼疮中的外周神经综合征比结节性动脉炎少见且更隐匿。已发现小发作三联征的生物电参数。在红斑狼疮中还注意到脊髓相对缺乏胶原病。此处受累的体征似乎有限且往往为亚急性。鉴别诊断必须考虑许多神经疾病，当模拟多发性硬化时这是一个特殊问题，就像在硬皮病中一样。由于约5%的患者脑部发作出现较早，使用抗惊厥药物，尤其是乙内酰脲类药物，会带来特殊问题。肌无力的体征需要进一步关注。神经病理学变化在要点上是已知的，显然很难与其他原因引起的炎症过程相混淆。某些基本事实似乎适用于其他胶原病。所有4种“大”或“经典”胶原病非常相似且有许多共同之处，但也或多或少存在明确差异。这在它们的临床和解剖表现上是如此，最后但同样重要的是在它们的神经学方面也是如此。“胶原病的‘顶层概念’”再次被证明是合理的。就目前所知，自主神经系统仅在硬皮病中起决定性和必不可少的作用。这种综合征也是唯一包含萎缩这一奇特现象的综合征，其中最著名的形式是面部半侧萎缩。
