Dicephalic parapagus twins
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.[3]
Their prospects are best if no attempt is made to separate them, except in cases where one twin is clearly dying.[6]
Terminology
Dicephalus means two-headed.[1] Parapagus means joined side by side.[7][1]
Dicephalic twins are called:
- dibrachius if they have two arms altogether (one for each twin),[3]
- tribrachius, if they have three arms altogether,[8]
- tetrabrachius, if they have four arms altogether,[7]
- dipus, if they have two legs altogether (one for each twin).[7]
Incidence
Conjoined twins appear in one in 50,000 to one in 100,000 births.[9] Dicephalic twins represent about 11 percent of all conjoined twins.[9]
Medical and social response
As late as the 1960s, some medical publications argued that newborn dicephalic twins should not be actively treated or resuscitated.[10] An attempt at surgical separation was reported in a paper published in 1982, but did not result in long-term survival of either twin.[11] In more recent cases in Turkey and Minnesota, doctors advised that separation surgery would not be appropriate.[12][13]
Dicephalic twins who survived past infancy
Giacomo and Giovanni Battista Tocci (1877–1940), were Italian male dicephalus parapagus twins who survived to adulthood.[9][14] Each had his own pair of arms.[14] They had two legs altogether, one of which was controlled by each twin.[15] They were exhibited in freak shows as children and teenagers. The Toccis learned to speak several languages,[16] but never learned to walk.[14]
Abby and Brittany Hensel, born in Minnesota in 1990, are another instance of dicephalus parapagus twins who grew up.[17] They were born with two functional arms, plus a vestigial third arm, which was surgically removed.[13] Each twin has her own complete head, heart and spine, and controls one arm and one leg.[13] They learned to walk around the same age as average children, went on to attend school, learn to drive, play sports,[13] and completed courses at college. They now teach in an elementary school.[18]
Twin girls conjoined like the Tocci brothers, with four arms and two legs altogether, were born in Turkey in 2000.[12] As with the Toccis and the Hensels, it was found that each twin controlled one leg.[19] Because of the size of their upper body, the Turkish twins needed a special program of exercises before they could learn to walk.[19] 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.[20]
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.[21]
- 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
- ^ 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.
- ^ Tewari, Mansi (April 10, 2014). ""Two-headed baby" born at Sonepat dies at AIIMS after 3 weeks". India Today. Retrieved April 15, 2016.
- ^ 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): 182.
- ^ Chatkupt, Surachat; Chervenak, Frank (February 1993). "Antepartum Diagnosis of Discordant Anencephaly in Dicephalic Conjoined Twins". J Clin Ultrasound (21): 138–142.
- ^ Başaran, Sibel; Sarpel, Tunay (2013). "Parapagus (dicephalus, tetrabrachius, dipus) conjoined twins and their rehabilitation" (PDF). Turkish Journal of Pediatrics (55): 102. Archived from the original (PDF) on 2016-01-31.
{{cite journal}}: Unknown parameter|deadurl=ignored (|url-status=suggested) (help) - ^ Quigley, Christine (2006). Conjoined Twins. McFarland. p. 56. ISBN 1476603235.
- ^ a b c Başaran, Sibel; Sarpel, Tunay (2013). "Parapagus (dicephalus, tetrabrachius, dipus) conjoined twins and their rehabilitation" (PDF). Turkish Journal of Pediatrics (55): 99. Archived from the original (PDF) on 2016-01-31.
{{cite journal}}: Unknown parameter|deadurl=ignored (|url-status=suggested) (help) - ^ Harma, M.; Oksuzier, C. (February 2005). "Vaginal delivery of dicephalic parapagus conjoined twins: case report and literature review". Tohoku J. Exp. Med. (205): 183.
- ^ a b c 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.
- ^ Quigley, Christine (2006). Conjoined Twins. McFarland. pp. 55–56. ISBN 1476603235.
- ^ 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.
- ^ a b Başaran, Sibel; Sarpel, Tunay (2013). "Parapagus (dicephalus, tetrabrachius, dipus) conjoined twins and their rehabilitation" (PDF). Turkish Journal of Pediatrics (55): 100. Archived from the original (PDF) on 2016-01-31.
{{cite journal}}: Unknown parameter|deadurl=ignored (|url-status=suggested) (help) - ^ a b c d Extraordinary people: the twins who share a body (video). UK: Five Life. 2007. Retrieved April 15, 2016.
- ^ a b c Başaran, Sibel; Sarpel, Tunay (2013). "Parapagus (dicephalus, tetrabrachius, dipus) conjoined twins and their rehabilitation" (PDF). Turkish Journal of Pediatrics (55): 102. Archived from the original (PDF) on 2016-01-31.
{{cite journal}}: Unknown parameter|deadurl=ignored (|url-status=suggested) (help) - ^ 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) - ^ Quigley, Christine (2006). Conjoined Twins. McFarland. p. 170. ISBN 1476603235.
- ^ Başaran, Sibel; Sarpel, Tunay (2013). "Parapagus (dicephalus, tetrabrachius, dipus) conjoined twins and their rehabilitation" (PDF). Turkish Journal of Pediatrics (55): 102–103. Archived from the original (PDF) on 2016-01-31.
{{cite journal}}: Unknown parameter|deadurl=ignored (|url-status=suggested) (help) - ^ "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.
- ^ a b Başaran, Sibel; Sarpel, Tunay (2013). "Parapagus (dicephalus, tetrabrachius, dipus) conjoined twins and their rehabilitation" (PDF). Turkish Journal of Pediatrics (55): 101. Archived from the original (PDF) on 2016-01-31.
{{cite journal}}: Unknown parameter|deadurl=ignored (|url-status=suggested) (help) - ^ Başaran, Sibel; Sarpel, Tunay (2013). "Parapagus (dicephalus, tetrabrachius, dipus) conjoined twins and their rehabilitation" (PDF). Turkish Journal of Pediatrics (55): 102. Archived from the original (PDF) on 2016-01-31.
{{cite journal}}: Unknown parameter|deadurl=ignored (|url-status=suggested) (help) - ^ "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.