Predicting Post-Traumatic Epilepsy from Clinical Records using Large Language Model Embeddings
Authors: Wenhui Cui, Nicholas Swingle, Anand A. Joshi, Dileep Nair, Richard M. Leahy
Organizations: Ming Hsieh Department of Electrical and Computer Engineering, University of Southern California, CA, USA · Epilepsy Center, Cleveland Clinic Neurological Institute, OH, USA
Objective: Post-traumatic epilepsy (PTE) is a debilitating neurological disorder that develops after traumatic brain injury (TBI). Early prediction of PTE remains challenging due to heterogeneous clinical data, limited positive cases, and reliance on resource-intensive neuroimaging data. We investigate whether routinely collected acute clinical records alone can support early PTE prediction using language model-based approaches. Methods: Using a curated subset of the TRACK-TBI cohort, we developed an automated PTE prediction framework that implements pretrained large language models (LLMs) as fixed feature extractors to encode clinical records. Tabular features, LLM-generated embeddings, and hybrid feature representations were evaluated using gradient-boosted tree classifiers under stratified cross-validation. Results: LLM embeddings achieved performance improvements by capturing contextual clinical information compared to using tabular features alone. The best performance was achieved by a modality-aware feature fusion strategy combining tabular features and LLM embeddings, achieving an AUC-ROC of 0.892 and AUPRC of 0.798. Acute post-traumatic seizures, injury severity, neurosurgical intervention, and ICU stay are key contributors to the predictive performance. Significance: These findings demonstrate that routine acute clinical records contain information suitable for early PTE risk prediction using LLM embeddings in conjunction with gradient-boosted tree classifiers. This approach represents a promising complement to imaging-based prediction.
Post-traumatic epilepsy (PTE) is a severe complication of traumatic brain injury (TBI). Yet, early identification remains challenging due to the complex structural and functional alterations it induces in the brain. To address this, we propose a dynamic multimodal Mixture-of-Experts (MoE) framework that integrates functional and structural connectivity through time-aware functional-structural encoding and class-conditioned expert routing. Within this framework, modality-specific and cross-modal experts learn complementary representations, while a Modality-Class MoE (MCoE) module dynamically adjusts expert weights according to each classification objective. Experimental results across three binary classification tasks demonstrate that the framework consistently outperforms static fusion baselines, and high-interpretability analyses further reveal meaningful regions of interest (ROIs) interactions. This dynamic multimodal expert framework effectively captures class-dependent brain interaction patterns and provides an interpretable approach for PTE diagnosis and risk stratification.
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.
Vigneshwar Hariharan, Chithra Reghuvaran, Arlene John +4
Joint-embedding predictive architectures (JEPA) learn representations by predicting in latent space, as in computer vision; retaining the action-conditioned predictor at inference turns them into latent world models, enabling planning in robotics (V-JEPA 2-AC). Bringing this design to EHR patient trajectories---a predictor that simulates a patient's trajectory in latent space---has not been explored. We use an LLM as the encoder, reading the hourly record as text, avoiding feature engineering and vocabulary harmonisation. But an LLM adapted by supervised fine-tuning does not organise its latent space around physiological dynamics, and freezing it to train the predictor, as in V-JEPA 2-AC, leaves the encoder unaware of the rollout signal: the predictor degrades under rollout. We instead co-train encoder and predictor under one latent-prediction objective, grounding the encoder in the dynamics its predictor must follow. Naïve co-training, however, is unstable: the untrained predictor drags the encoder toward collapse, and the predictor's rollout diverges as its target space moves. We present Clin-JEPA, a five-phase curriculum that stably co-trains an LLM encoder with a latent trajectory predictor on MIMIC-IV. Three evaluations support the design: (1) under 48-hour autoregressive rollout the co-trained predictor degrades least (predictor degradation ×1.06, against ×1.23--1.36 for two-stage designs and ×6.3--66 for curriculum ablations) while the co-trained encoder resolves the progression of patient state most sharply (largest state displacement); (2) the co-trained encoder separates deteriorating from stable patients in its latent space with Cohen's d=1.59, against ≤0.50 for two-stage encoders; (3) one set of embeddings serves 34 downstream tasks across three benchmarks, outperforming strong per-task tuned baselines and a pretrained EHR foundation model.