Epileptic Seizure Prediction Using Patient-Adaptive Transformer Networks

Epilepsy is one of the most common neurological disorders globally, characterized by recurring seizures and significantly impacting the quality of life. Despite advancements in diagnostic techniques, the mitigation of risks faced by epilepsy patients remains challenging due to the unpredictability of seizure events. An accurate forecast of seizure onset helps to reduce risks in epilepsy patients. In this paper, we propose EEG-FuseFormer, a transformer-based feature fusion framework for seizure-onset prediction that combines intermediate features extracted from Convolutional Neural Networks-Long Short-Term Memory (CNN-LSTM) and ResNet-18 networks. The CNN-LSTM architecture captures both spatial and temporal features directly from the raw signal, whereas the ResNet-18 extracts features from the Short-Time Fourier Transform (STFT) representation of the EEG signals. Fusion is carried out using a transformer encoder, and the final prediction is generated using fully connected dense layers. The CHB-MIT dataset was used to validate the proposed model. The results show that the proposed model achieves a mean recall of 98.85% and outperforms most of the state-of-the-art methods. This study evaluates the ability of the proposed feature fusion model to generalize in cross-patient testing scenarios. Fine-tuning pre-trained models on limited target patient data (target adaptation) within the cross-patient validation framework results in higher recall, precision, and F1-score metrics in comparison to the conventional cross-patient validation approach. Finally, the runtime-based computational complexity of the model is assessed across diverse hardware platforms to highlight the performance-complexity trade-off.

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.

Neonatal seizures carry substantial risks of acute brain injury and long-term neurodevelopmental impairment, motivating the need for timely identification of impending seizure activity. While continuous electroencephalogram (EEG) monitoring remains the clinical gold standard, reliable patient-independent seizure prediction in neonates remains largely under-explored. We propose an interpretable multimodal framework that combines EEG and electrocardiogram (ECG) signals for neonatal seizure prediction. Our method uses mel-frequency cepstral coefficient (MFCC) representations processed by a lightweight (approx. 70k-parameter) convolutional neural network with squeeze-and-excitation attention. The framework was evaluated on the Helsinki neonatal EEG-ECG dataset and the Siena scalp EEG-ECG dataset. Under strict leave-one-patient-out (LOPO) evaluation, patient-independent prediction proved challenging (mean accuracy 58.5%, F1-score 60.3%), highlighting substantial inter-subject variability in neonatal EEG. However, fine-tuning the pretrained model with only five minutes of patient-specific data per class improved performance to 95.87% accuracy and 95.85% F1-score, demonstrating the feasibility of rapid patient-adaptive transfer learning. SHapley Additive exPlanations (SHAP) identified informative EEG channels that showed partial spatial agreement with clinically reported seizure origins. These findings suggest that fully patient-independent neonatal seizure prediction remains challenging, but that patient-adaptive fine-tuning with a small amount of data may provide a practical pathway toward personalized neonatal seizure prediction systems.