EEGDM: Label-Efficient EEG Representation Learning with Generative Diffusion Model

Deep learning for EEG-based seizure detection faces critical challenges: severe annotation scarcity and extreme class imbalance, where ictal events comprise less than 10% of clinical recordings. We present DiffEEG, a 9.6M-parameter self-supervised foundation model that addresses both limitations through denoising diffusion pre-training and reinforcement learning (RL)-based fine-tuning. Pre-trained on 1.3M unlabeled segments from the Temple University Hospital Seizure Corpus (TUHSZ), DiffEEG learns generic neural representations via a 1D U-Net with multi-head self-attention. For downstream adaptation, a reinforced decision layer employs policy gradient optimization to directly maximize F1-score, prioritizing sensitivity to rare seizure events over overall accuracy. Under strict patient-wise evaluation (279 patients, Leave-One-Fold-Out), DiffEEG achieves 61% accuracy and 59% F1 for 4-class seizure subtyping, and 81% accuracy with 85% weighted F1 for binary detection, maintaining clinically viable seizure recall (59%) despite extreme imbalance (6.7% prevalence). Segment-level evaluation establishes an upper bound of 97.6% accuracy, confirming strong architectural capacity. DiffEEG demonstrates that diffusion-based pre-training combined with metric-aware reinforcement learning enables clinically deployable seizure monitoring with minimal labeled data requirements.

Recent advances in self-supervised learning for EEG representation have largely relied on masked reconstruction, where models are trained to recover randomly masked signal segments. While effective at modeling local dependencies, the training objective of masked reconstruction does not compel the model to capture global generative constraints essential for characterizing neural activity. To address this limitation, we propose EEGDM, a novel self-supervised framework that leverages latent diffusion models to generate EEG signals as an objective. Unlike masked reconstruction, diffusion-based generation progressively denoises signals from noise to realism, compelling the model to capture holistic temporal patterns and cross-channel relationships. Specifically, EEGDM incorporates an EEG encoder that distills raw signals and their channel augmentations into a compact representation, which serves as conditional information to guide the diffusion denoising process, thereby enabling the encoder and diffusion model to be jointly optimized through the generative objective. This design endows EEGDM with a compact latent space, which not only offers ample control over the generative process but also can be leveraged for downstream tasks. Experimental results show that EEGDM (1) reconstructs high-quality EEG signals, (2) learns robust representations, and (3) achieves competitive performance across diverse downstream tasks, thus exploring a new direction for self-supervised EEG representation learning.

Electroencephalography (EEG) models used for epilepsy are often limited to specific datasets and tasks. This limited approach can make it challenging to apply these models across different datasets or in various situations. However, recent studies in foundation models and self-supervised learning suggest that an adaptable EEG backbone could support a range of EEG related tasks. In this study, we have developed a multimodal EEG foundation model that combines a raw signal encoder based on the Mamba architecture, a Vision Transformer (ViT)-style encoder for time-frequency data, and a lightweight encoder for text, all within a shared embedding space. The pretraining process relies on several innovative techniques, such as masked modeling, cross-view contrastive alignment, and temporal consistency losses. These methods are designed to create rich, seizure-relevant representations without requiring labeled data. To assess the efficacy and generalization of our pretrained model, we fine-tuned it on the canonical CHB-MIT seizure detection benchmark and additional seizure detection datasets, and conducted extensive experiments comparing different model variants. On the standard CHB-MIT split, our best single model achieved an AUROC of 0.874, and an ensemble variant reached 0.878 AUROC, representing state-of-the-art performance on this benchmark. In addition to standard train-test splits, we evaluated performance under a leave-one-subject-out (LOSO) protocol, which is rarely reported in prior EEG seizure modeling work and highlights the difficulty of patient-independent seizure detection, with a mean LOSO balanced accuracy of 0.558 across 19 subjects. Across datasets and evaluation settings, our multimodal foundation model enabled robust seizure detection and straightforward adaptation to new seizure detection scenarios, while also supporting interpretable seizure localization.