Foundation models for discovering robust biomarkers of neurological disorders from dynamic functional connectivity

Objective. EEG foundation models (FMs) report strong accuracy on clinical resting-state EEG. However, high accuracy under subject-disjoint cross-validation remains ambiguous: it can reflect a genuine clinical biomarker, or subject-identity features that correlate with the label. We name this the Identity Trap and ask whether it can be diagnosed at the representation level before fine-tuning. Approach. We propose FMScope, a frozen-representation protocol packaging five diagnostics: variance decomposition, subject-axis erasure, aperiodic 1/f ablation, layer-wise label probing, and within-subject direction consistency. We apply it to three pretrained FMs (LaBraM, CBraMod, REVE) across four datasets in a 2x2 layout: subject relation of label x presence of a consensus cross-subject EEG marker. Main results. (i) The Identity Trap is universal: frozen subject-variance is 13-89x a random null in 12/12 pairs, rising in all 12 under fine-tuning (+10 to +63 pp). This dominance is a removable linear axis: erasing it improves label decoding where the label varies within subject (+6 to +12 pp in primary cells; +4 to +27 pp across external cohorts). (ii) Aperiodic 1/f is one subject carrier: removing it drops the subject probe by 9-19 pp on LaBraM and CBraMod. REVE saturates subject identity without measurable aperiodic dependence. (iii) Fine-tuning amplifies label-variance only in cells with a literature-established cross-subject marker. Significance. The Identity Trap is a physically-grounded instance of shortcut learning: the preferred cue has a measurable physiological component, and subject-disjoint splitting alone cannot rule it out. FMScope separates gains reflecting a biological marker from those reflecting subject identity.

EEG foundation models (EEG-FMs) have been evaluated predominantly on clean, in-distribution accuracy, leaving their robustness, interpretability and representational quality largely unexamined. This study addresses these gaps by benchmarking six EEG-FMs against a baseline deep learning model across eight datasets. Beyond clean accuracy, we conduct three layers of analysis: (i) Robustness: we apply test-time perturbations including additive noise, random and region-based channel dropout and region-specific noise injection. Our analyses show that no single model dominates all failure modes. The most noise-robust model is among the most fragile under channel dropout and much of the dropout fragility disappears when channels are removed rather than zero-padded. (ii) Interpretability: we present the first application of Attention-Aware Layer-Wise Relevance Propagation (AttnLRP) to EEG-FMs and show that models broadly concentrate relevance on task-appropriate brain regions consistent with known neurophysiology. However, attribution maps remain spatially stable under perturbation while predictions degrade, suggesting that the models attend to the correct brain regions but decode corrupted content. (iii) Expressiveness: With block-wise probing we show that late blocks are repurposed during fine-tuning, while early blocks already hold task-related information. Furthermore, we demonstrate that the poor head-only performance previously attributed to low-quality pre-trained representations is largely explained by pooling and that EEG-FMs possess sufficient representational capacity when their token-level embeddings are preserved. Together, these findings provide the first systematic assessment of robustness, interpretability and expressiveness for EEG-FMs and highlight critical considerations for their development.

Foundation models (FMs) promise to extract unified representations that generalize across downstream tasks. They have emerged across fields, including electroencephalography (EEG), but it is less clear how effective they are in this particular field. Published evaluations differ in datasets, in the EEG-specific preprocessing that might influence reported results, and in the reported metrics, frequently obscuring the clinical relevance in EEG. We introduce NeuroAtlas, the largest EEG benchmark to date: 42 datasets and 260k hours covering clinical EEG (epilepsy, sleep medicine, brain age estimation) and brain-computer interfaces, and include multiple datasets per task along with bespoke clinical evaluation metrics. Besides evaluating EEG-FMs with respect to supervised baselines, we present results from generic time-series FMs. We report three findings. First, EEG-specific FMs do not consistently outperform time-series FMs, which have neither EEG-focused architectures nor been pretrained on EEG. Second, standard machine learning metrics are insufficient to assess clinical utility: thus, we thoroughly evaluate more appropriate measures such as the quality of event-level decision-making, hypnogram-derived features, and the brain-age gap in the domains of epilepsy, sleep, and brain age, respectively. Third, model rankings and performance can vary substantially within domains. We conclude that pretrained models perform largely on par, with only narrow advantages for a few, and that current models do not yet deliver on the promise of an out-of-the-box unified EEG model. NeuroAtlas exposes this gap and provides the datasets and metrics for the next generation of unified EEG FMs.