Craniopagus Conjoined Twins

1. Craniopagus Conjoined Twins Their Cognition and Separate Personality Types By: Kelsey Simon

2. Question • How is it that craniopagus conjoined twins can have a connected brain but their cognition can be completely separate from the other twin and in all cases, have different personalities?

3. Hypothesis…Or Maybe Not • I didn’t really have a hypothesis of what I thought the reason pertained to. I really had nothing to form my idea around because I really knew nothing about craniopagus conjoined twins. The only thing I expected was that the craniopagus conjoined twins’ level of cognition had to do with the brain (nature) and not nurture.

4. The Search • For this topic, I was looking for individual cases of craniopagus conjoined twins that would give me a description of the physical makeup of the conjoined brain and the joint abilities as a result of the conjoined brain. • I do not think that I realized that all craniopagus conjoined twins have different amounts of their brains connected. This made the topic even more interesting to me because then I got to research the abilities of conjoined twins that non-conjoined people can not experience.

5. In this presentation we will look at three sets of conjoined twins. 1. Trishna and Krishna 2. Tatiana and Krista 3. George and Lori • We will compare and contrast these sets of twins focusing on the different physical structures of their brains and the different abilities that come along with that. We will also note the different personalities that arise in these twins.

6. Terms You Need To Know • Craniopagus conjoined twins- conjoined twins that are fused at the cranium; do not always have to share brain surface but most do • Thalamus- the sensory processing center of the brain

7. 1.)Trishna and Krishna: Major Findings

8. Trishna and Krishna: Background Info • Trishna and Krishna were left by their mother at a Bangladeshi orphanage. Trishna was very ill from heart failure and both the girls were expected to die within 6 months. • The Children First Foundation brought Trishna and Krishna to Royal Children’s Hospital in Australia for their separation surgery. Moira Kelley, who is head of the Children First Foundation now calls herself their mother.

9. Trishna and Krishna: Twins Successfully Separated • Trishna and Krishna were separated November 16 and 17 of 2009. • Separating conjoined twins especially craniopagus conjoined twins is one of the most dangerous surgeries that can be performed, so the fact that these two little girls survived is a miracle in itself. • Doctors estimated that the girls had a 25% chance of coming out of the surgery successfully. • It took 31.5 hours to separate the twins.

10. Trishna and Krishna: Life After Separation • Trishna recovered into a normal healthy child but Krishna has had ongoing problems with her heart, blood pressure, and kidneys. They are overall living healthy with their caretaker Moria Kelley.

11. Trishna and Krishna: How Brain Was Connected • Trishna and Krishna’s brain had almost no shared surface area. Mainly the only shared part of the brain was interconnected blood vessels that created blood flow between the two brains. • Severing the blood vessels was the only part of the procedure that was somewhat problematic. When the doctors first started to reduce blood flow, Trishna’s blood pressure rose while Krishna’s went down. As the became

12. Trishna and Krishna: How Brain Was Connected Cont. more separated, they recovered and seemed to be doing even better than when they had been fully connected.

13. What Conclusions/Questions Can We Draw From Trishna’s And Krishna’s Separation? • From the separation of Trishna and Krishna, we know that craniopagus twins can be separated, but to what extent? • Trishna and Krishna only shared blood vessels but what if they had shared parts of the brain? Could they have separated them then? • We will find out from our next two set of twins that not all craniopagus twins can be separated.

14. 2.)Tatiana and Krista Hogan: Major Findings

15. Tatiana and Krista Hogan: Background Info • Tatiana and Krista Hogan were born on October 25, 2006 in Vernon, British Columbia, Canada. • At age two, the girls still could not walk and could hardly talk.

16. Tatiana and Krista Hogan: Connection Of The Nervous System • Tatiana and Krista Hogan have a neural bridge that connects one girls thalamus to the others. The thalamus is the sensory processing station of the brain. All sensory impute goes through the thalamus before it goes to the cortex. • This connection allows one twin to receive the sensory impute that the other twin experiences.

17. Tatiana and Krista Hogan: Examples Of Shared Sensory Experiences • You can put a stuffed animal in front of Tatiana and cover Krista’s eyes, yet Krista can still tell you what stuffed animal it is. Both twins have this ability. • If you touch one twin, the other twin can tell you were you have touched the first twin. • If you tickle one twin, the other will giggle in response as if you had tickled her. • When one twin is receiving sensory impute the other ones eyes will be directed straight forward with this glazed over look; their pupils will then move back and forth very fast, which some believe to be the result of seeing what the other twin is seeing.

18. Tatiana and Krista Hogan: Connection Of The Shared Cardiovascular System • Tatiana and Krista have shared blood vessels and arteries in the brain. • Tatiana’s heart technically beats for both herself and her sister because 1/5th to 1/4th of the blood supply in Krista’s brain comes from Tatiana’s heart. • The responsibility of Tatiana’s heart to pump blood for two people has caused her to have high blood pressure.

19. Tatiana and Krista Hogan: Physical Differences and Other Medical Issues • Tatiana and Krista are different in size. Tatiana has grown but remains small and very skinny. Krista resembles any normal growing child in size. • The girls also had seizures for the first year and a half of their lives but they are both on medication now, so the episodes no longer occur.

20. Tatiana and Krista Hogan: Separate Personalities • Tatiana is more layed back and will do most of what Krista tells her to. Krista is very assertive and somewhat aggressive. It has become a habit for Krista to scratch Tatiana’s face when Tatiana does not listen to her.

21. 3.)George (Reba) and Lori Schappell

22. George (Reba) and Lori Schappell: Background Info • George and Lori were born September 18, 1961. • There legal names given by their parents were Dori and Lori. Dori resented her parents deeply for giving her and her twin rhyming names so she got her name legally changed to Reba after her favorite country music singer. She now goes by George, although that is not her legal name. • They are the oldest living female conjoined twins in the world. • They lived in a home for severely mentally ill patients for 24 years.

23. George (Reba) and Lori Schappell: Connection Of Their Brains • George and Lori share blood vessels connecting their brains. • George and Lori share 30% of their brain being that both of their frontal lobes and parietal lobes are connected, but they do have two fully functioning brains that seem to function separately.

24. George (Reba) and Lori Schappell: Physical Problems • George has a type of spina bifida that leaves her four inches shorter than her conjoined twin Lori and has also left her paralyzed. She has a stool that she designed herself that allows her to go where her sister goes. • Doctors are beginning to think that the gene that causes spina bifida may also be directly related in causing conjoined twins.

25. George (Reba) and Lori Schappell: Separate Personalities And Goals in Life George Lori Outspoken Extraverted Social Butterfly Works part-time dealing with hotel laundry. Is facilitator to George’s mobility • Introverted • George is a country singer who won the L.A. Music Award for Best New Country Artist in 1997. • Also a trophy winning bowling winner • Has designed many mobility machines for handicapped animals and people. • Both George and Lori • They both say that the only way they would be separated is if one of them dies and the other stays alive. Then and only then would they even consider being separated.

26. Answers To The Questions Presented With Trishna and Krishna Questions: Answers: There comes a point where you can not separate craniopagus conjoined twins any longer. If they share brain surface or if the have a neural connection between any structures of the brain, they cannot be separated.

27. Main Findings • Some twins can be separated if they do not share structures of the brain, such as Trishna and Krishna, and have few connecting blood vessels that are not vital to the others blood supply; so you would need the opposite conditions from Tatiana and Krista’s case. • Some twins can actually share brain structures, which can allow them to have special connections with each others cognition, like in Tatiana and Krista’s example of sharing a thalamus and receiving each others sensory impute.

28. Main Findings Cont. • Some twins do not want to be separated, such as in George and Lori’s case. • There may be an underlying gene connected with spina bifida that can also cause conjoined twins. Spina bifida is when the spinal cord does not fully develop leaving gaps in it. Almost just like how conjoined twins are made, where a fertilized egg that splits to form two twins does not split all of the way.

29. Answering My Initial Question • The question was: How is it that craniopagus conjoined twins can have a connected brain but their cognition can be completely separate from the other twin and in all cases, have different personalities? • My answer after having done this research would be: Craniopagus twins joint cognition depends on how much of the brain and which parts of the brain have a neural connection between twins. In most cases, craniopagus conjoined twins have two separate brains with all functioning parts that just share blood vessels or brain surface. It is rare, but can happen as we saw, that craniopagus twins share a brain structure, which in this case, they would share more cognition.

30. Answering My Initial Question Cont. • Regarding different personalities, I did not find much information on why personalities are so different among twins with connected brains, I just found that they are. It almost seems that in conjoined twins, there is a greater difference in personality than in just regular siblings but yet there is much better communication and cooperation.

31. The End

32. Picture Citations • Picture on slide 8: http://www.google.com/imgres?imgurl=http://3.bp.blogspot.com/_P1RHqFsgywM/SwVj2pWBSvI/AAAAAAAAEmw/hFqyiGFr_S8/s1600/baby2.jpg&imgrefurl=http://yesboleh.blogspot.com/2009/11/bangladeshi-twins-stable-after-miracle.html&usg=__PuXFfFKKryB15TO5Ccb66COZSd4=&h=349&w=465&sz=30&hl=en&start=8&zoom=1&tbnid=JOWmSjAlQmHx6M:&tbnh=173&tbnw=222&ei=Ar3eTfvcNorWgQfU2dDnCg&prev=/search%3Fq%3Dtrishna%2Band%2Bkrishna%2Bbefore%2Bthey%2Bwere%2Bseparated%26um%3D1%26hl%3Den%26biw%3D1229%26bih%3D508%26tbm%3Disch&um=1&itbs=1&iact=hc&vpx=931&vpy=207&dur=1430&hovh=194&hovw=259&tx=133&ty=144&page=2&ndsp=10&ved=1t:429,r:4,s:8&biw=1229&bih=508 • Picture on slide 9: • http://www.google.com/imgres?imgurl=http://o.aolcdn.com/photo-hub/news_gallery/6/3/638114/1258381140090.JPEG&imgrefurl=http://www.aolnews.com/2009/11/16/conjoined-twins-face/&usg=__D5Uu4dduCwBcrMImG6ZmJXRnPBw=&h=304&w=456&sz=28&hl=en&start=0&zoom=1&tbnid=RqYsIKxhHRba8M:&tbnh=165&tbnw=255&ei=Ar3eTfvcNorWgQfU2dDnCg&prev=/search%3Fq%3Dtrishna%2Band%2Bkrishna%2Bbefore%2Bthey%2Bwere%2Bseparated%26um%3D1%26hl%3Den%26biw%3D1229%26bih%3D508%26tbm%3Disch&um=1&itbs=1&iact=hc&vpx=915&vpy=147&dur=595&hovh=183&hovw=275&tx=78&ty=120&page=1&ndsp=8&ved=1t:429,r:3,s:0&biw=1229&bih=508 • Picture for slide 10: • http://www.google.com/imgres?imgurl=http://www.abc.net.au/reslib/200912/r491312_2551338.JPG&imgrefurl=http://www.abc.net.au/news/stories/2010/07/10/2950146.htm&usg=___pyCsEJ_k_yGqtTT3eGw517OdAs=&h=840&w=563&sz=72&hl=en&start=38&zoom=1&tbnid=kybCik1vwxTe1M:&tbnh=175&tbnw=117&ei=Ar3eTfvcNorWgQfU2dDnCg&prev=/search%3Fq%3Dtrishna%2Band%2Bkrishna%2Bbefore%2Bthey%2Bwere%2Bseparated%26um%3D1%26hl%3Den%26biw%3D1229%26bih%3D508%26tbm%3Disch&um=1&itbs=1&iact=hc&vpx=542&vpy=110&dur=598&hovh=175&hovw=117&tx=74&ty=121&page=5&ndsp=10&ved=1t:429,r:2,s:38&biw=1229&bih=508 • Top Picture for slide 15: http://www.google.com/imgres?imgurl=http://4.bp.blogspot.com/_KAPAJNZXLe0/S9X9tWevhII/AAAAAAAAARI/bfDWVU3bFCY/s1600/kt1.jpg&imgrefurl=http://brunchforone.blogspot.com/2010/04/krista-tatiana-hogan-siamese-twin.html&usg=__2YiNpWvM3tVRRb1h8TlMRCQUVpc=&h=416&w=600&sz=89&hl=en&start=0&zoom=1&tbnid=6Dvp2RaATMdapM:&tbnh=117&tbnw=160&ei=mYLfTZGaDITVgAegxpXzCg&prev=/search%3Fq%3Dtatiana%2Band%2Bkrista%2Bhogan%26um%3D1%26hl%3Den%26biw%3D1229%26bih%3D508%26tbm%3Disch&um=1&itbs=1&iact=hc&vpx=285&vpy=69&dur=1175&hovh=187&hovw=270&tx=149&ty=98&page=1&ndsp=18&ved=1t:429,r:1,s:0&biw=1229&bih=508

33. Picture Citations Cont. • Bottom Picture for slide 15: • http://www.google.com/imgres?imgurl=http://www.anorak.co.uk/wp-content/uploads/Tatiana-and-Krista-Hogan.jpg&imgrefurl=http://www.anorak.co.uk/264603/strange-but-true/tatiana-and-krista-hogan-share-a-brain-vision-and-dreams.html&usg=__8KOkx5HzIHoXEJHUipYYTFqxsQk=&h=303&w=468&sz=20&hl=en&start=0&zoom=1&tbnid=7HLrI6RNtxoVBM:&tbnh=117&tbnw=160&ei=mYLfTZGaDITVgAegxpXzCg&prev=/search%3Fq%3Dtatiana%2Band%2Bkrista%2Bhogan%26um%3D1%26hl%3Den%26biw%3D1229%26bih%3D508%26tbm%3Disch&um=1&itbs=1&iact=hc&vpx=797&vpy=72&dur=156&hovh=181&hovw=279&tx=170&ty=79&page=1&ndsp=18&ved=1t:429,r:4,s:0&biw=1229&bih=508 • Picture for slide 19: • http://www.google.com/imgres?imgurl=http://1.bp.blogspot.com/_Fe6rGp1YNm8/TGIRZ10xmfI/AAAAAAAAGpU/fQxLHxVU_Q0/s1600/1.jpg&imgrefurl=http://freeamazingimages.com/2010/08/conjoined-twins-share-brain.html&usg=__vHSmugFWi2l-GeYkVEgJu677peA=&h=411&w=531&sz=52&hl=en&start=0&zoom=1&tbnid=Y-PhoNeGJbxxeM:&tbnh=117&tbnw=180&ei=mODeTdPbH4SDgAf-psXmCg&prev=/search%3Fq%3Dtatiana%2Band%2Bkrista%2Bhogan%26um%3D1%26hl%3Den%26sa%3DN%26biw%3D1229%26bih%3D508%26tbm%3Disch&um=1&itbs=1&iact=rc&dur=475&page=1&ndsp=18&ved=1t:429,r:4,s:0&tx=109&ty=81&biw=1229&bih=508 • Pictures from slide 23 captured from: http://www.youtube.com/watch?v=5aBhHfV1dDc • Picture from slide 24: • http://www.google.com/imgres?imgurl=http://4.bp.blogspot.com/_Kyg9p1QlyzQ/SlGXFaBrphI/AAAAAAAAAH4/hFAil_hvj9Q/s400/schappell_sisters5.jpg&imgrefurl=http://jekasari.blogspot.com/2009/07/lori-dori-schappell.html&usg=__uQgc2zGIlRxaM_pNshKfiS726zs=&h=400&w=258&sz=24&hl=en&start=0&zoom=0&tbnid=HZiQa8KNczE9TM:&tbnh=119&tbnw=79&ei=0GzfTfvjOcLegQeA7NjkCg&prev=/search%3Fq%3Dgeorge%2Bschappell%2Band%2Bher%2Bwheelchair%26um%3D1%26hl%3Den%26sa%3DX%26biw%3D1229%26bih%3D508%26tbm%3Disch&um=1&itbs=1&iact=hc&vpx=957&vpy=235&dur=472&hovh=124&hovw=80&tx=81&ty=85&page=1&ndsp=24&ved=1t:429,r:14,s:0&biw=1229&bih=508

34. Source Citations Books Gibbs, Jr., R. W. . (2006). Embodiment and cognitive science . New York, NY: Cambridge University Press Online Magazine Articles Hui, Y. (2010, November 9th). Conjoined twins’ brains connect, share thoughts. Health, Retrieved from http://cogsnews.ucsd.edu/?p=63 MacQueen, K. (2011, May 24). A piece of their mind. Macleans.ca, Retrieved from http://www2.macleans.ca/2010/11/02/a-piece-of-their-mind/print/ University Scientific Department Blog Beebout , S. (2009, April 14). Blurring the definition of self, agency, and identity [Web log message]. Retrieved from http://serendip.brynmawr.edu/exchange/node/4158 Other Blog Websites Anderson, Elizabeth. (2009). phreequeshow [Web log message]. Retrieved from http://www.phreeque.com/schappell_sisters.html Videos “Extreme Bodies; Separating Cranial Conjoined Twins”. How Stuff Works.  http://videos.howstuffworks.com/discovery/32215-extreme-bodies-separating-cranial-conjoined-twins-video.htm (2007). Canadian conjoined twins face critical operation [Web]. Available from http://www.liveleak.com Other Videos Without Production Info. • http://www.youtube.com/watch?v=42A0GdmQ02M • http://www.youtube.com/watch?v=7pR2uWhAkaQ • http://www.youtube.com/watch?v=5aBhHfV1dDc