{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T10:01:18Z","timestamp":1784282478193,"version":"3.55.0"},"reference-count":63,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2025,12,10]],"date-time":"2025-12-10T00:00:00Z","timestamp":1765324800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Background and Objective: Lennox\u2013Gastaut syndrome (LGS) is a severe developmental and epileptic encephalopathy characterized by multiple seizure types, distinctive electroencephalography (EEG) abnormalities, and cognitive impairment. Sleep disturbances are highly prevalent in LGS and contribute substantially to reduced quality of life. However, no comprehensive analysis has yet been conducted to systematically examine key aspects of sleep\u2014including architecture, microstructure, sleep-disordered breathing, and circadian regulation\u2014leaving critical knowledge gaps. To address this, we conducted a scoping review to map the current evidence on sleep abnormalities in LGS and to identify priorities for future research. Method: A scoping review was conducted following PRISMA-ScR guidelines. PubMed, Embase, Ovid, and ClinicalTrials.gov from inception to October 2025 for studies evaluating sleep parameters in individuals with LGS or mixed epilepsy cohorts with \u226550% LGS cases. Eligible designs included observational and interventional studies using polysomnography, video-EEG, actigraphy, or sleep questionnaires. Data were synthesized narratively due to heterogeneity, and methodological quality was assessed using relevant Joanna Briggs Institute (JBI) checklists. Results: After screening 1242 articles, eleven studies met inclusion criteria, spanning 1986\u20132025 and conducted across four continents. Most were small single-center observational studies (5\u201316 LGS participants) using polysomnography as the primary assessment, with others employing wearable monitoring, surface and intracranial EEG, or circadian biomarker analyses. Across studies, individuals with LGS demonstrated markedly disrupted sleep architecture\u2014notably reduced or absent rapid eye movement (REM) sleep, fragmented non-rapid eye movement (NREM) sleep, and attenuated spindles. Microstructural analysis showed elevated cyclic alternating pattern (CAP) rates, with epileptiform discharges clustering in CAP phase A. Sleep-disordered breathing (SDB) was common, particularly in adults, and associated with tonic seizures and central apneas. Circadian rhythm dysregulation, including altered melatonin and cortisol profiles, was also reported. A feasibility study demonstrated that home-based wearable devices and sleep apnea monitors were both acceptable and practical for use in children with LGS. No interventional studies have evaluated whether addressing sleep abnormalities modifies seizure or cognitive outcomes. Interpretation: Sleep in LGS is profoundly disrupted at both macrostructural and microstructural levels. These abnormalities may exacerbate seizure burden, cognitive impairment, and SUDEP risk, representing a potentially modifiable contributor to disease severity. Larger, prospective studies integrating polysomnography, wearable monitoring, and interventional approaches are needed to clarify causal mechanisms and therapeutic potential.<\/jats:p>","DOI":"10.3390\/children12121676","type":"journal-article","created":{"date-parts":[[2025,12,10]],"date-time":"2025-12-10T12:20:57Z","timestamp":1765369257000},"page":"1676","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Sleep in Lennox\u2013Gastaut Syndrome: A Scoping Review"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5154-8717","authenticated-orcid":false,"given":"Debopam","family":"Samanta","sequence":"first","affiliation":[{"name":"Division of Child Neurology, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR 72202, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,10]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1398","DOI":"10.1111\/epi.17241","article-title":"ILAE classification and definition of epilepsy syndromes with onset in childhood: Position paper by the ILAE Task Force on Nosology and definitions","volume":"63","author":"Specchio","year":"2022","journal-title":"Epilepsia"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"107612","DOI":"10.1016\/j.yebeh.2020.107612","article-title":"Management of Lennox-Gastaut syndrome beyond childhood: A comprehensive review","volume":"114","author":"Samanta","year":"2021","journal-title":"Epilepsy Behav."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Archer, J.S., Warren, A.E., Jackson, G.D., and Abbott, D.F. (2014). Conceptualizing lennox-gastaut syndrome as a secondary network epilepsy. Front. Neurol., 5.","DOI":"10.3389\/fneur.2014.00225"},{"key":"ref_4","unstructured":"LGS Foundation (2025, October 29). Understanding Sleep Challenges in Lennox-Gastaut Syndrome. Available online: https:\/\/www.lgsfoundation.org\/wp-content\/uploads\/2025\/09\/LGS-Sleep-Report.pdf."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1016\/j.yebeh.2017.09.006","article-title":"Lennox-Gastaut syndrome in adulthood: Long-term clinical follow-up of 38 patients and analysis of their recorded seizures","volume":"77","author":"Vignoli","year":"2017","journal-title":"Epilepsy Behav."},{"key":"ref_6","first-page":"e1508","article-title":"Nocturnal supervision and SUDEP risk at different epilepsy care settings","volume":"91","author":"Hesdorffer","year":"2018","journal-title":"Neurology"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"109932","DOI":"10.1016\/j.yebeh.2024.109932","article-title":"The emotional burden of caring for patients with Lennox-Gastaut syndrome, Dravet syndrome, and tuberous sclerosis complex-associated epilepsy: A qualitative study in Japan","volume":"158","author":"LoPresti","year":"2024","journal-title":"Epilepsy Behav."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1387","DOI":"10.1378\/chest.14-0970","article-title":"International classification of sleep disorders","volume":"146","author":"Sateia","year":"2014","journal-title":"Chest"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"537","DOI":"10.1016\/S1389-9457(01)00149-6","article-title":"Atlas, rules, and recording techniques for the scoring of cyclic alternating pattern (CAP) in human sleep","volume":"2","author":"Terzano","year":"2001","journal-title":"Sleep Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"597","DOI":"10.5664\/jcsm.2172","article-title":"Rules for scoring respiratory events in sleep: Update of the 2007 AASM manual for the scoring of sleep and associated events: Deliberations of the sleep apnea definitions task force of the American Academy of Sleep Medicine","volume":"8","author":"Berry","year":"2012","journal-title":"J. Clin. Sleep Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1224","DOI":"10.1212\/WNL.36.9.1224","article-title":"Sleep patterns in the Lennox-Gastaut syndrome","volume":"36","author":"Amir","year":"1986","journal-title":"Neurology"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1016\/j.yebeh.2014.03.009","article-title":"Sleep alterations in children with refractory epileptic encephalopathies: A polysomnographic study","volume":"35","author":"Carotenuto","year":"2014","journal-title":"Epilepsy Behav."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1016\/S0920-1211(01)00280-7","article-title":"Sleep in Lennox-Gastaut syndrome: The role of the cyclic alternating pattern (CAP) in the gate control of clinical seizures and generalized polyspikes","volume":"46","author":"Eisensehr","year":"2001","journal-title":"Epilepsy Res."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"A551","DOI":"10.1093\/sleep\/zsaf090.1279","article-title":"1279 Feasibility of Ambulatory Sleep Assessment in Children with Lennox-Gastaut Syndrome","volume":"48","author":"Gupta","year":"2025","journal-title":"Sleep"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"627","DOI":"10.1016\/S0387-7604(87)80098-0","article-title":"Overnight polygraphic study of Lennox-Gastaut syndrome","volume":"9","author":"Horita","year":"1987","journal-title":"Brain Dev."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"410","DOI":"10.1007\/BF00867353","article-title":"Melatonin, cortisol and body temperature rhythms in Lennox-Gastaut patients with or without circadian rhythm sleep disorders","volume":"240","author":"Laakso","year":"1993","journal-title":"J. Neurol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1684\/epd.2016.0793","article-title":"Nocturnal interictal epileptic discharges in adult Lennox-Gastaut syndrome: The effect of sleep stage and time of night","volume":"18","author":"Sforza","year":"2016","journal-title":"Epileptic Disord."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1157","DOI":"10.1002\/epi4.12772","article-title":"Sleep and respiratory abnormalities in adults with developmental and epileptic encephalopathies using polysomnography and video-EEG monitoring","volume":"8","author":"Sivathamboo","year":"2023","journal-title":"Epilepsia Open"},{"key":"ref_19","first-page":"S117","article-title":"Sleep-epilepsy interactions in patients with intractable generalized tonic seizures and depth electrodes in the centro median thalamic nucleus","volume":"26","author":"Velasco","year":"1995","journal-title":"Arch. Med. Res."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1016\/S1388-2457(01)00707-6","article-title":"Temporo-spatial correlations between scalp and centromedian thalamic EEG activities of stage II slow wave sleep in patients with generalized seizures of the cryptogenic Lennox\u2013Gastaut syndrome","volume":"113","author":"Velasco","year":"2002","journal-title":"Clin. Neurophysiol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1016\/S0987-7053(01)00290-8","article-title":"Spike-wave discharge and the microstructure of sleep-wake continuum in idiopathic generalised epilepsy","volume":"32","author":"Terzano","year":"2002","journal-title":"Neurophysiol. Clin.\/Clin. Neurophysiol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1309","DOI":"10.1111\/j.1528-1157.1998.tb01329.x","article-title":"Interictal spiking increases with sleep depth in temporal lobe epilepsy","volume":"39","author":"Malow","year":"1998","journal-title":"Epilepsia"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1016\/j.ejpn.2022.03.010","article-title":"Sleep in children with refractory epilepsy and epileptic encephalopathies: A systematic review of literature","volume":"38","author":"Proost","year":"2022","journal-title":"Eur. J. Paediatr. Neurol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"107320","DOI":"10.1016\/j.yebeh.2020.107320","article-title":"How do children with drug-resistant epilepsy sleep? A clinical and video-PSG study","volume":"114","author":"Arhan","year":"2021","journal-title":"Epilepsy Behav."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"763","DOI":"10.1177\/08830738030180110601","article-title":"Sleep organization in children with partial refractory epilepsy","volume":"18","author":"Ferri","year":"2003","journal-title":"J. Child Neurol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1519","DOI":"10.1111\/j.1528-1167.2012.03558.x","article-title":"The impact of epilepsy on sleep architecture during childhood","volume":"53","author":"Pereira","year":"2012","journal-title":"Epilepsia"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"487","DOI":"10.1016\/j.seizure.2012.04.005","article-title":"Markedly disturbed sleep in medically refractory compared to controlled epilepsy\u2013a clinical and polysomnography study","volume":"21","author":"Zanzmera","year":"2012","journal-title":"Seizure"},{"key":"ref_28","first-page":"5405","article-title":"Overnight video-polysomnographic studies in children with intractable epileptic encephalopathies","volume":"24","author":"Lehman","year":"2018","journal-title":"Med. Sci. Monit. Int. Med. J. Exp. Clin. Res."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"322","DOI":"10.1111\/j.1528-1157.1999.tb00712.x","article-title":"Lamotrigine associated with insomnia","volume":"40","author":"Sadler","year":"1999","journal-title":"Epilepsia"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"575","DOI":"10.1007\/s10072-010-0291-8","article-title":"Polysomnographic assessment of sleep disturbances in children with developmental disabilities and seizures","volume":"31","author":"Miano","year":"2010","journal-title":"Neurol. Sci."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"zsac041","DOI":"10.1093\/sleep\/zsac041","article-title":"Non-rapid eye movement sleep instability in adults with epilepsy: A systematic review and meta-analysis of cyclic alternating pattern","volume":"45","author":"Yeh","year":"2022","journal-title":"Sleep"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"246","DOI":"10.1016\/j.ijpsycho.2013.07.009","article-title":"Sleep cyclic alternating pattern and cognition in children: A review","volume":"89","author":"Novelli","year":"2013","journal-title":"Int. J. Psychophysiol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"e245564","DOI":"10.1136\/bcr-2021-245564","article-title":"Obstructive and central sleep apnoea in a patient with medically intractable epilepsy","volume":"15","author":"Schwartz","year":"2022","journal-title":"BMJ Case Rep."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"101416","DOI":"10.1016\/j.smrv.2021.101416","article-title":"Sleep disruption in children and adolescents with epilepsy: A systematic review and meta-analysis","volume":"57","author":"Winsor","year":"2021","journal-title":"Sleep Med. Rev."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1210\/jc.2009-0435","article-title":"Sleep-disordered breathing in obese children is associated with prevalent excessive daytime sleepiness, inflammation, and metabolic abnormalities","volume":"95","author":"Tsaoussoglou","year":"2010","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1151","DOI":"10.1002\/ppul.20943","article-title":"Inflammation and sleep disordered breathing in children: A state-of-the-art review","volume":"43","author":"Goldbart","year":"2008","journal-title":"Pediatr. Pulmonol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"572","DOI":"10.1212\/01.wnl.0000323927.13250.54","article-title":"Treating obstructive sleep apnea in adults with epilepsy: A randomized pilot trial","volume":"71","author":"Malow","year":"2008","journal-title":"Neurology"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"359","DOI":"10.1016\/j.pediatrneurol.2012.03.005","article-title":"Effect of treatment of obstructive sleep apnea on seizure outcomes in children with epilepsy","volume":"46","author":"Segal","year":"2012","journal-title":"Pediatr. Neurol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1007\/s11325-013-0858-8","article-title":"Central sleep apnea and complex sleep apnea in patients with epilepsy","volume":"18","author":"Vendrame","year":"2014","journal-title":"Sleep Breath."},{"key":"ref_40","unstructured":"(2025, November 01). Beacon Biosignals Reports Novel Sleep EEG Results from Multiple Industry Collaborations at the American Epilepsy Society Annual Meeting. Available online: https:\/\/beacon.bio\/news\/beacon-biosignals-reports-novel-sleep-eeg-results-from-multiple-industry-collaborations-at-the-american-epilepsy-society-annual-meeting."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1111\/epi.12478","article-title":"Effects of epilepsy treatments on sleep architecture and daytime sleepiness: An evidence-based review of objective sleep metrics","volume":"55","author":"Jain","year":"2014","journal-title":"Epilepsia"},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Samanta, D. (2025). Perampanel, brivaracetam, cenobamate, stiripentol, and ganaxolone in lennox-gastaut syndrome: A comprehensive narrative review. J. Clin. Med., 14.","DOI":"10.3390\/jcm14176302"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"110787","DOI":"10.1016\/j.yebeh.2025.110787","article-title":"Cenobamate in pediatric epilepsy and developmental and epileptic encephalopathies: Efficacy, safety, and syndrome-specific considerations","volume":"173","author":"Samanta","year":"2025","journal-title":"Epilepsy Behav."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"110261","DOI":"10.1016\/j.yebeh.2024.110261","article-title":"Antiseizure medications for Lennox-Gastaut Syndrome: Comprehensive review and proposed consensus treatment algorithm","volume":"164","author":"Samanta","year":"2025","journal-title":"Epilepsy Behav."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"107280","DOI":"10.1016\/j.eplepsyres.2023.107280","article-title":"Caregiver-reported outcomes with real-world use of cannabidiol in Lennox-Gastaut syndrome and Dravet syndrome from the BECOME survey","volume":"200","author":"Berg","year":"2024","journal-title":"Epilepsy Res."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1207","DOI":"10.1007\/s40263-021-00867-0","article-title":"Effect of Cannabidiol on Interictal Epileptiform Activity and Sleep Architecture in Children with Intractable Epilepsy: A Prospective Open-Label Study","volume":"35","author":"Klotz","year":"2021","journal-title":"CNS Drugs"},{"key":"ref_47","doi-asserted-by":"crossref","unstructured":"Samanta, D. (2024). Efficacy and Safety of Vagus Nerve Stimulation in Lennox-Gastaut Syndrome: A Scoping Review. Children, 11.","DOI":"10.3390\/children11080905"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"107499","DOI":"10.1016\/j.eplepsyres.2024.107499","article-title":"Neuromodulation Strategies in Lennox-Gastaut Syndrome: Practical Clinical Guidance from the Pediatric Epilepsy Research Consortium","volume":"210","author":"Samanta","year":"2025","journal-title":"Epilepsy Res."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"110067","DOI":"10.1016\/j.yebeh.2024.110067","article-title":"Neuromodulation strategies in developmental and epileptic encephalopathies","volume":"160","author":"Samanta","year":"2024","journal-title":"Epilepsy Behav."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"4324","DOI":"10.1111\/epi.18544","article-title":"Comparative efficacy of neuromodulation therapies in Lennox\u2013Gastaut syndrome: A systematic review and meta-analysis of vagus nerve stimulation, deep brain stimulation, and responsive neurostimulation","volume":"66","author":"Samanta","year":"2025","journal-title":"Epilepsia"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1111\/epi.17811","article-title":"Effects of vagus nerve stimulation on the quality of sleep and sleep apnea in patients with drug-resistant epilepsy: A systematic review","volume":"65","author":"Seth","year":"2024","journal-title":"Epilepsia"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"e99","DOI":"10.1111\/epi.13045","article-title":"Deep brain stimulation of anterior nucleus thalami disrupts sleep in epilepsy patients","volume":"56","author":"Voges","year":"2015","journal-title":"Epilepsia"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"588","DOI":"10.1016\/j.seizure.2009.06.002","article-title":"Centro-median stimulation yields additional seizure frequency and attention improvement in patients previously submitted to callosotomy","volume":"18","author":"Cukiert","year":"2009","journal-title":"Seizure"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1111\/j.1528-1167.2006.00834.x","article-title":"Ketogenic diet improves sleep quality in children with therapy-resistant epilepsy","volume":"48","author":"Lundgren","year":"2007","journal-title":"Epilepsia"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"1098","DOI":"10.1016\/S1474-4422(18)30335-1","article-title":"Circadian rhythm and epilepsy","volume":"17","author":"Khan","year":"2018","journal-title":"Lancet Neurol."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.seizure.2016.05.014","article-title":"Clobazam higher-evening differential dosing as an add-on therapy in refractory epilepsy","volume":"40","author":"Klehm","year":"2016","journal-title":"Seizure"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1111\/j.0013-9580.2003.12006.x","article-title":"Sleep oscillations developing into seizures in corticothalamic systems","volume":"44","author":"Steriade","year":"2003","journal-title":"Epilepsia"},{"key":"ref_58","first-page":"297","article-title":"Polygraphic characterization of the sleep-epilepsy patterns in a hydranencephalic child with severe generalized seizures of the Lennox-Gastaut syndrome","volume":"28","author":"Velasco","year":"1997","journal-title":"Arch. Med. Res."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"101236","DOI":"10.1016\/j.spen.2025.101236","article-title":"Lennox-Gastaut Syndrome: Progress, Challenges, and Future Directions","volume":"56","author":"Samanta","year":"2025","journal-title":"Semin. Pediatr. Neurol."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"2818","DOI":"10.1002\/acn3.52211","article-title":"Clinical trials for Lennox\u2013Gastaut syndrome: Challenges and priorities","volume":"11","author":"Knowles","year":"2024","journal-title":"Ann. Clin. Transl. Neurol."},{"key":"ref_61","doi-asserted-by":"crossref","unstructured":"Niknazar, M., Krishnan, G.P., Bazhenov, M., and Mednick, S.C. (2015). Coupling of thalamocortical sleep oscillations are important for memory consolidation in humans. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0144720"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"1940","DOI":"10.1038\/s41598-018-36557-z","article-title":"Precise slow oscillation\u2013spindle coupling promotes memory consolidation in younger and older adults","volume":"9","author":"Muehlroth","year":"2019","journal-title":"Sci. Rep."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"1360","DOI":"10.1111\/epi.17938","article-title":"Circadian changes in aperiodic activity are correlated with seizure reduction in patients with mesial temporal lobe epilepsy treated with responsive neurostimulation","volume":"65","author":"Charlebois","year":"2024","journal-title":"Epilepsia"}],"container-title":["Children"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9067\/12\/12\/1676\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,10]],"date-time":"2025-12-10T12:55:18Z","timestamp":1765371318000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9067\/12\/12\/1676"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,10]]},"references-count":63,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["children12121676"],"URL":"https:\/\/doi.org\/10.3390\/children12121676","relation":{},"ISSN":["2227-9067"],"issn-type":[{"value":"2227-9067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,10]]}}}