CLEF: EEG Foundation Model for Learning Clinical Semantics

Clinical electroencephalogram (EEG) analysis rests on a hand-crafted feature catalog refined over decades, \emph{e.g.,} band power, connectivity, complexity, and more. Modern EEG foundation models bypass this catalog, learn directly from raw signals via self-supervised pretraining, and match or outperform feature-engineered baselines on most clinical benchmarks. Whether the two representations align is an open question, which we decompose into three sub-questions: \emph{what does the model learn}, \emph{what does the model use}, and \emph{how much can be explained}. We answer them with layer-wise ridge probing, LEACE-style cross-covariance subspace erasure, and a transparent classifier benchmarked against a random-feature baseline. The audit covers three foundation models (CSBrain, CBraMod, LaBraM), five clinical tasks (MDD, Stress, ISRUC-Sleep, TUSL, Siena), and a 6-family 63-feature lexicon. Of the $945$ (model, task, feature) units, $648$ ($68.6\%$) are representation-causal and $199$ ($21.1\%$) are encoded-only. Across tasks, $50$ features qualify as universal candidates with strong support (all three architectures RC) in two or more tasks. Frequency-domain features dominate, but the other five families each contribute substantial causal mass. Confirmed features recover, on average, $79.3\%$ of the foundation model's advantage over the random baseline, with a clean task gradient (MDD $\approx 0.99$ down to Stress $\approx 0.56$): tasks near ceiling are almost fully recovered by the lexicon, while harder tasks leave a non-trivial residual that pinpoints a concrete target for future concept discovery.

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.

Electroencephalography (EEG) foundation models aim to learn reusable representations from large-scale unlabeled recordings. A common pretraining strategy is masked waveform reconstruction, but applying supervision directly to noisy EEG may encourage models to recover predictable background activity, acquisition effects, and artifacts rather than neural structure that transfers across tasks. This raises a central question: what should an EEG foundation model predict to learn transferable representations? We introduce EEG-JEPA a structured latent-prediction framework for EEG foundation modeling. Rather than reconstructing masked voltage samples, a masked context encoder and predictor infer contextual latent states produced by an exponential-moving-average target encoder that observes the complete input. EEG-JEPA organizes target design along three complementary dimensions: target content specifies what representation is predicted, target support specifies where prediction occurs over structured electrode--time regions through Neurotopology-Aware Multi-scale Electrode-Temporal Masking (N-MET), and target depth specifies at which encoder layers supervision is applied. Together, these designs shift EEG pretraining from recovering missing measurements to inferring latent states from structured electrode--time context. We evaluate EEG-JEPA through controlled objective comparisons, frozen multitask transfer, and full fine-tuning. Under the same backbone, pretraining corpus, and training duration, EEG-JEPA improves the 14-task frozen macro balanced accuracy from 40.49% to 50.42% over CBraMod-style masked waveform reconstruction. Multi-source continuation further raises this result to 52.94%, the highest average among the EEG foundation models evaluated on EEG-FM-Bench. Under protocol-matched full fine-tuning, EEG-JEPA also improves the nine-task average balanced accuracy from 68.98% to 70.65%.