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Dicephalic parapagus twins

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Giacomo and Giovanni Battista Tocci

Dicephalic parapagus is a rare form of partial twinning where there are two heads side by side on one torso.[1] Infants conjoined this way are sometimes called "two-headed babies" in popular media.[2] The condition is also called parapagus dicephalus.[1]

If carried to term, most dicephalic twins are stillborn, or die soon after birth.[3] A small number are known to have survived to adulthood.[3]

The extent to which limbs and organs are duplicated varies from case to case. One head may be only partially developed (anencephalic),[4] or both may be complete. In some cases, two complete hearts are present as well, which improves their chances of survival.[5] The total number of arms may be two, three or four.[6]

Their prospects are best if no attempt is made to separate them, except in cases where one twin is clearly dying.[7]

Terminology

Skeletal structure of dicephalic twins. From: Hirst & Piersol, 1893.

Dicephalus means two-headed.[1] Parapagus means joined side by side.[8][1]

Dicephalic twins are called

  • dibrachius if they have two arms altogether (one for each twin),[3]
  • tribrachius, if they have three arms altogether,[9]
  • tetrabrachius, if they have four arms altogether,[8]
  • dipus, if they have two legs altogether (one for each twin).[8]

Incidence

As a general class, conjoined twins appear in 1 in 50 thousand to 1 in 100 thousand births.[10] Dicephalic twins represent about 11 percent of all conjoined twins.[10]

Medical and social response

As late as the 1960s, some medical publications argued that newborn dicephalic twins should not be actively treated or resuscitated.[11] An attempt at surgical separation were reported in a paper published in 1982, but did not result in long-term survival of either twin.[12] In more recent cases in Turkey and Minnesota, doctors advised that separation surgery would not be appropriate.[13][14]

Dicephalic twins who survived past infancy

Giacomo and Giovanni Battista Tocci (1877 - 1940), were Italian male dicephalus parapagus twins who survived to adulthood.[15][16] Each had his own pair of arms.[16] They had two legs altogether, one of which was controlled by each twin.[17] They were exhibited in freak shows as children and teenagers. The Toccis learned to speak several languages,[18] but never learned to walk.[16]

Abigail and Brittany Hensel, born in Minnesota in 1990, are another instance of dicephalus parapagus twins who grew up.[19] They were born with two functional arms, plus a vestigial third arm, which was surgically removed.[14] Each twin has her own complete head, heart and spine, and controls one arm and one leg.[14] They learned to walk around the same age as average children, went on to attend school and play sports,[14] and completed courses at university.[20]

Twin girls conjoined like the Tocci brothers, with four arms and two legs altogether, were born in Turkey in 2000.[13] As with the Toccis and the Hensels, it was found that each twin controlled one leg.[21] Because of the size of their upper body, the Turkish twins needed a special program of exercises before they could learn to walk.[21] After that, they learned to run and climb stairs without further specialist help, and at age 11 they were going to school with other children.[22]

See also

  • Craniopagus parasiticus is another form of partial twinning which results in two heads kept alive by a single torso. In these cases a second, vestigial torso is present, and the heads are joined directly to one another.[23]
  • Diprosopus is a condition in which there are duplicated facial features on one head.
  • Polycephaly is a general term about organisms with more than one head.

References

  1. ^ a b c d Harma, M.; Oksuzier, C. (February 2005). "Vaginal delivery of dicephalic parapagus conjoined twins: case report and literature review". Tohoku J. Exp. Med. (205): 179.
  2. ^ Tewari, Mansi (April 10, 2014). ""Two-headed baby" born at Sonepat dies at AIIMS after 3 weeks". India Today. Retrieved April 15, 2016.
  3. ^ a b c Harma, M.; Oksuzier, C. (February 2005). "Vaginal delivery of dicephalic parapagus conjoined twins: case report and literature review". Tohoku J. Exp. Med. (205): 182.
  4. ^ Chatkupt, Surachat; Chervenak, Frank (February 1993). "Antepartum Diagnosis of Discordant Anencephaly in Dicephalic Conjoined Twins". J Clin Ultrasound (21): 138–142.
  5. ^ Başaran, Sibel; Sarpel, Tunay (2013). "Parapagus (dicephalus, tetrabrachius, dipus) conjoined twins and their rehabilitation" (PDF). Turkish Journal of Pediatrics (55): 102.
  6. ^ Harma, M.; Oksuzier, C. (February 2005). "Vaginal delivery of dicephalic parapagus conjoined twins: case report and literature review". Tohoku J. Exp. Med. (205): 182.
  7. ^ Quigley, Christine (2006). Conjoined Twins. McFarland. p. 56. ISBN 1476603235.
  8. ^ a b c Başaran, Sibel; Sarpel, Tunay (2013). "Parapagus (dicephalus, tetrabrachius, dipus) conjoined twins and their rehabilitation" (PDF). Turkish Journal of Pediatrics (55): 99.
  9. ^ Harma, M.; Oksuzier, C. (February 2005). "Vaginal delivery of dicephalic parapagus conjoined twins: case report and literature review". Tohoku J. Exp. Med. (205): 183.
  10. ^ a b Bondeson, Jan (September 2001). "Dicephalus conjoined twins: A historical review with emphasis on viability". Journal of Pediatric Surgery. 36 (9): 1435–1444. doi:10.1053/jpsu.2001.26393.
  11. ^ Quigley, Christine (2006). Conjoined Twins. McFarland. p. 55-56. ISBN 1476603235.
  12. ^ Golladay, E.S.; Shenefelt, Ray (1982). "Dicephalus dipus conjoined twins: A surgical separation and review of previously reported cases". Journal of Pediatric Surgery. 17 (3): 259–264. doi:10.1016/s0022-3468(82)80008-0.
  13. ^ a b Başaran, Sibel; Sarpel, Tunay (2013). "Parapagus (dicephalus, tetrabrachius, dipus) conjoined twins and their rehabilitation" (PDF). Turkish Journal of Pediatrics (55): 100.
  14. ^ a b c d Extraordinary people: the twins who share a body (video). UK: Five Life. 2007. Retrieved April 15, 2016.
  15. ^ Bondeson, Jan (September 2001). "Dicephalus conjoined twins: A historical review with emphasis on viability". Journal of Pediatric Surgery. 36 (9): 1435–1444. doi:10.1053/jpsu.2001.26393.
  16. ^ a b c Başaran, Sibel; Sarpel, Tunay (2013). "Parapagus (dicephalus, tetrabrachius, dipus) conjoined twins and their rehabilitation" (PDF). Turkish Journal of Pediatrics (55): 102.
  17. ^ Bondeson, Jan (2004). The two-headed boy, and other medical marvels. Ithaca: Cornell University Press,. p. 177. ISBN 9780801489587.{{cite book}}: CS1 maint: extra punctuation (link)
  18. ^ Quigley, Christine (2006). Conjoined Twins. McFarland. p. 170. ISBN 1476603235.
  19. ^ Başaran, Sibel; Sarpel, Tunay (2013). "Parapagus (dicephalus, tetrabrachius, dipus) conjoined twins and their rehabilitation" (PDF). Turkish Journal of Pediatrics (55): 102–103.
  20. ^ "School, shopping, sunbathing… normal activities in an extraordinary world: Conjoined twins Abigail and Brittany Hensel offer a glimpse in to their lives in a new reality TV series". Daily Mail (Australia). 29 August 2012. Retrieved April 16, 2016.
  21. ^ a b Başaran, Sibel; Sarpel, Tunay (2013). "Parapagus (dicephalus, tetrabrachius, dipus) conjoined twins and their rehabilitation" (PDF). Turkish Journal of Pediatrics (55): 101.
  22. ^ Başaran, Sibel; Sarpel, Tunay (2013). "Parapagus (dicephalus, tetrabrachius, dipus) conjoined twins and their rehabilitation" (PDF). Turkish Journal of Pediatrics (55): 102.
  23. ^ "Craniopagus parasiticus: A rare case". Journal of Clinical Neuroscience. 17: 1351–1352. October 2010. doi:10.1016/j.jocn.2010.01.053. Retrieved 2012-10-16.
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