Classification of IED-free EEG Responses for Assisted Epilepsy Diagnosis

Source-level analysis of interictal epileptiform discharges (IEDs) is relevant to presurgical evaluation and treatment planning because it helps characterize where epileptiform activity is likely to arise. Beyond detecting whether an IED is present, this setting requires assigning IED-positive activity to clinically meaningful brain-region categories. This setting is challenging because source-region evidence in short electroencephalography (EEG) windows can be subtle, partial, and affected by subject variability, class imbalance, and imperfect multimodal context. We present EEGBind, an EEG-centric multimodal binding framework for five-class source-level IED classification. EEGBind treats EEG as the primary modality and binds synchronized video-context features around an EEG-centric representation. Instead of relying on early or overly strong multimodal fusion, which may perturb the source-sensitive EEG representation, EEGBind uses video context as auxiliary evidence for robust classification. A view-consistent repair stage is further used to improve hidden-set robustness while preserving the learned source-class boundary. On the NeuroMM 2026 Grand Challenge Track 3 NMM-Source-IED benchmark, EEGBind achieves 0.8395 on weighted-F1 and outperforms strong competitors. These results support EEG-centric multimodal binding as a practical strategy for source-level IED classification. The open-source code is available at https://github.com/HKUSTGZ-ML4Health-Lab/NeuroMM2026_IED_Detection.

Automated detection of interictal epileptiform discharges in scalp electroencephalography (EEG) is clinically important, but recent high-performing deep-learning models often trade interpretability for accuracy. We introduce EEG-SpikeAgent, a closed-loop program-synthesis framework that uses a large language model (LLM) agentic system to generate signal-processing features for spike detection in scalp EEG. The system iteratively proposes one deterministic EEG feature module at a time, executes the resulting code on EEG to generate tabular features, evaluates performance via a tabular classifier, summarizes run-level metrics, and feeds structured diagnostics back to the model for refinement. Across iterations, EEG-SpikeAgent proposes and refines candidate signal features and decision rules informed by model performance. We evaluated EEG-SpikeAgent on VEPISET, a public 29-channel dataset of 4-second epochs containing 2,516 discharge-containing and 22,933 non-discharge epochs. Across five-fold cross-validation with a gradient-boosted tree classifier, agent-generated features achieved an area under the receiver operating characteristic curve of 0.935, balanced accuracy of 0.699, F1 score of 0.557, sensitivity of 0.401, and specificity of 0.996 at the default operating point. At an operating point with sensitivity 0.80, mean precision was 0.470 and mean specificity was 0.900. Artifact-aware feature generation improved balanced accuracy and F1 score over spike-only feature search. These results indicate that LLM-based program synthesis can automate EEG feature engineering in auditable and inspectable code-driven manner for clinical and methodological review.

Accurate identification of the epileptogenic zone (EZ) is essential for seizure freedom after resective surgery in drug-resistant epilepsy, yet seizure freedom rates remain below 50%. We developed EpiiSLM, a dual foundation model system for EZ identification with stereo-electroencephalography (sEEG), by training a signal foundation model on 104,990 minutes of sEEG recordings from the Montreal Neurological Institute & Hospital, while leveraging all recordings regardless of surgical outcome and anchoring EZ biomarker extraction on non-epileptic signals. A language foundation model then integrates sEEG-derived outputs with multimodal clinical information to produce interpretable predictions. Under leave-one-patient-out evaluation, EpiiSLM achieved 0.978 contact-level positive predictive value (PPV), outperforming the seizure onset zone(SOZ)-as-EZ baseline by 15.1% (p < 0.05), and 100% region-level accuracy; on an external dataset, EpiiSLM achieved 0.857 contact-level PPV. EpiiSLM requires only one night of interictal sleep data, suggesting potential to reduce invasive sEEG monitoring duration and improve surgical outcomes.