Honest and Reliable Evaluation and Expert Equivalence Testing of Automated Neonatal Seizure Detection

Despite strong performance on held-out electroencephalography (EEG) data, seizure detectors may fail under real-world acquisition variability, artifacts, and adversarial inputs. We introduce RobustSeiz, an open-source, model-agnostic framework that provides a standardized, reproducible protocol for stress-testing and comparing seizure detectors under controlled, clinically motivated distribution shifts before deployment. We standardize four public scalp-EEG corpora (CHB-MIT, TUSZ, Siena, and SeizeIT1) into BIDS-EEG trees and evaluate subject-independent detectors on held-out splits. Environment, noise, and adversarial transforms are swept over predefined hyperparameter grids. Each run reports sample- and event-level sensitivity, precision, F1, false positives per 24 h, Lead and Lag onset timing, and Monte Carlo dropout predictive agreement. RobustSeiz includes a Dockerized GPU pipeline, experiment registry, and full-evaluation and research-subset modes. We demonstrate the framework with a contemporary seizure detector on TUSZ across the complete implemented shift grid; an AWGN analysis illustrates how perturbation severity changes detection quality, onset timing, and predictive agreement. RobustSeiz provides a shared benchmarking standard for evaluating seizure-detector robustness under realistic clinical stressors, extending pre-deployment assessment beyond clean-data accuracy.

Most existing seizure detection algorithms require extensive pre-processing of the data and rely on heuristic or currently unexplainable machine learning approaches. These approaches often struggle with balancing detection sensitivity and specificity in the presence of variable seizure morphologies, interictal epileptiform discharges, and artefacts. Here, we consider an alternative approach: our seizure detection algorithm, which is based on the concept of critical transitions and overcomes the aforementioned limitations. Specifically, we perform a receiver-operating-characteristic analysis to quantify the performance of our algorithm in terms of its agreement with expert annotations of seizure onset and offset times in the voltage recordings of seizure activity in epileptic rodents with different seizure morphologies. We demonstrate how performance depends on algorithm parameters and varies across different rodent recording sessions. We determine the optimal set of algorithm parameters for each recording session, with near expert-level performance achieved in most cases. Finally, we derive a single general set of algorithm parameters applicable across all recording sessions. The algorithm maintains its high performance in this general setting, demonstrating its versatility, robustness across varying seizure morphologies, and potential to complement machine learning algorithms.

While Multimodal Large Language Models (MLLMs) have demonstrated remarkable proficiency in general video understanding, their capacity to interpret involuntary, and spatio-temporally evolving pathologic motor behaviors such as seizure semiology remains largely untested. To address this gap, we introduce Seizure-Semiology-Suite, a clinically grounded dataset and benchmark for fine-grained, structured seizure semiology understanding. The dataset includes 438 seizure videos annotated with over 35,000 dense labels covering 20 ILAE-defined semiological features. Building on this dataset, we propose a seven-task hierarchical benchmark that systematically evaluates MLLMs from low-level visual perception to temporal sequencing, narrative report generation, and seizure diagnosis. To enable clinically meaningful evaluation of generated reports, we further introduce the Report Quality Index for Seizure Semiology (Seizure-RQI). Extensive baselines across 11 open-weight MLLMs reveal systematic weaknesses in laterality reasoning, temporal localization, symptom sequencing, and clinically faithful reporting. We show that seizure-specific fine-tuning substantially improves performance across tasks, and that a two-stage neuro-symbolic framework achieves an F1 score of 0.96 on epileptic versus non-epileptic seizure classification. Seizure-Semiology-Suite establishes a rigorous benchmark for evaluating multimodal models in safety-critical medical video understanding and guides the development of clinically reliable, domain-adaptive multimodal intelligence.