Dicephalic parapagus twins

Dicephalic parapagus \ dī-ˈsef-ə-lək \ is a rare form of partial twinning with 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]

B. C. Hirst & G. A. Piersol, Human monstrosities. Wellcome L0027955.

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 in which one twin is clearly dying.[6]

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

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, also are 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.

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.[18] Because of the size of their upper body, the Turkish twins needed a special program of exercises before they could learn to walk.[18] 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.[19]

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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.[20]
  • 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. 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. 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 (2): 138–142. doi:10.1002/jcu.1870210212.
  5. 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.
  6. Quigley, Christine (2006). Conjoined Twins. McFarland. p. 56. ISBN 1476603235.
  7. 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.
  8. Harma, M.; Oksuzier, C. (February 2005). "Vaginal delivery of dicephalic parapagus conjoined twins: case report and literature review". Tohoku J. Exp. Med. (205): 183.
  9. 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.
  10. Quigley, Christine (2006). Conjoined Twins. McFarland. pp. 55–56. ISBN 1476603235.
  11. 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.
  12. 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.
  13. Extraordinary people: the twins who share a body (video). UK: Five Life. 2007. Retrieved April 15, 2016.
  14. 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.
  15. Bondeson, Jan (2004). The two-headed boy, and other medical marvels. Ithaca: Cornell University Press. p. 177. ISBN 9780801489587.
  16. Quigley, Christine (2006). Conjoined Twins. McFarland. p. 170. ISBN 1476603235.
  17. 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.
  18. 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.
  19. 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.
  20. Kansal, Ritesh; Kale, Chirag; Goel, Atul (October 2010). "Craniopagus parasiticus: A rare case". Journal of Clinical Neuroscience. 17 (10): 1351–1352. doi:10.1016/j.jocn.2010.01.053. PMID 20655232.
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