NeuroAtlas: Benchmarking Foundation Models for Clinical EEG and Brain-Computer Interfaces
Authors: Konstantinos Kontras, Trui Osselaer, Stylianos G. Mouslech, Angeliki-Ilektra Karaiskou, Guido Gagliardi, Thomas Strypsteen, Mohammad Hossein Badiei, Anku Rani, +7 more
Organizations: KU Leuven · MIT
Abstract
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) supports a variety of brain-computer interface (BCI) tasks ranging from brain-state monitoring to human-LLM interactions. EEG foundation models are emerging, but evaluation remains fragmented due to heterogeneous datasets and nconsistent task protocols. Here, we introduce OmniEEG-Bench, a unified benchmark and downstream task roadmap for EEG foundation models (FMs). It organizes evaluation of EEG FMs into six task families spanning (i) signal reliability, (ii) biometrics and disease, (iii) consciousness and state, (iv) cognition and emotion, (v) naturalistic stimulus decoding, and (vi) motor and interaction, introducing a new generation of tasks not systematically benchmarked in prior EEG FM work. OmniEEG-Bench standardizes model deployment, task definitions, and metrics through a task-card specification, and unifies 54 EEG datasets with consistent evaluation protocols. We benchmark 10 representative EEG foundation models and report a leaderboard that covers diverse evaluation settings. Both pretraining dataset diversity and model size are significantly associated with better average ranks across datasets, revealing scaling-law behavior in EEG foundation models (Figure 1). These results suggest that scaling EEG foundation models requires not only larger architectures but also broader and more diverse pretraining data. The benchmark code is available at https://github.com/ncclab-sustech/omni-eegbench.git.
Evaluating foundation models under appropriate adaptation settings is essential for understanding the quality and transferability of the learned representations. Recent EEG foundation models have demonstrated promising transfer capabilities across tasks and datasets, motivating their growing use in neurotechnology and clinical applications. However, these models are typically evaluated under full fine-tuning on well-curated downstream datasets, a setting that does not reflect biomedical domain constraints such as limited labeled data, reduced sensor coverage, or parameter-efficient adaptation. In this work, we propose a multi-dimensional evaluation framework for assessing EEG models under realistic low-resource conditions. Empirical analysis of both supervised EEG models and recent EEG foundation models, including LaBraM, CSBrain, and CBraMod, across 6 different datasets is performed under the proposed multi-dimensional evaluation framework. We find that EEG foundation models consistently provide performance gains on long-context tasks such as sleep stage prediction and mental health state classification. In contrast, for short-window Brain Computer Interface style tasks, supervised models achieve comparable despite having substantially fewer parameters. Additional analyses demonstrate that current foundation models provide limited robustness to short-window tasks and channel constrained settings. Together, these findings motivate the use of multi-dimensional evaluation protocols that characterize model behavior under realistic use constraints.
Pretrained EEG foundation models are proposed for clinical decoding, but whether reported gains transfer across populations or survive negative controls is unclear. We benchmark LaBraM, EEGMamba, CBraMod, REVE, LEAD, BENDR, and BIOT on five clinical tasks across four datasets. Primary analyses use frozen linear probes with subject-disjoint LOSO or grouped five-fold validation. Because CAUEEG releases no patient identifiers, it is evaluated at recording level with a patient-disjoint sensitivity. We challenge apparent gains using stronger classical comparators, label permutation, scrambled-label fine-tuning, and random-initialisation controls. In a matched 19-channel CAUEEG evaluation (Normal/MCI/Dementia; N = 1,187 recordings), classical features achieve 0.734 macro-AUROC versus 0.699 for BIOT, 0.669 for CBraMod, and 0.568 for REVE. A patient-disjoint sensitivity retains the classical-over-REVE ordering (0.717 versus 0.565). Dataset identity is decoded from frozen REVE embeddings at or near ceiling across Western-Korean and Western-Western pairs, including after PCA-50 and removal of line-frequency and amplitude-scale information. This establishes dataset membership, not a causal site or population effect. A matched random-initialised encoder exceeds pretrained REVE on CAUEEG (0.659 versus 0.570). On CHB-MIT cross-subject ictal detection (n = 23), REVE reaches 0.793, versus 0.739 for the best enhanced nonlinear comparator, 0.701 for random initialisation, and 0.505 for raw-signal random features. Because preprocessing removes absolute amplitude, this does not establish superiority over every plausible handcrafted baseline. Conclusions change materially after montage matching, patient-overlap checks, stronger comparators, and representation controls. We distill these checks into a reporting protocol for clinical EEG foundation-model studies.