Literature-Guided Minimax Optimization of Virtual Epilepsy Neurostimulation

Specialist epilepsy expertise is scarce in resource-constrained settings, making LLM-based decision support attractive for frontline clinicians managing longitudinal treatment. Such systems must adapt to local prescribing practice and know when to defer. We study this problem in Ugandan pediatric epilepsy care, predicting anti-seizure medication regimens from longitudinal unstructured clinic notes. Standard prompting achieves non-trivial agreement with physician prescriptions, but neurologist review shows that many errors reflect distribution-miscalibrated prescribing defaults rather than failures to parse the local record. We introduce MANANA, a non-parametric prompt-learning framework that learns local prescribing guidance from a small patient-level training set. MANANA converts observed prescription errors into auditable prompt memories, instantiated in single-agent and multi-agent variants, and improves over classical ML models, direct LLM prompting, and prompt-optimization baselines across two independently collected Ugandan cohorts. We further propose Bayesian prompt averaging, which converts the learned prompt trajectory into prescription likelihoods and an uncertainty-based deferral signal. On the independently collected held-out cohort, this improves visit-level top-3 prescription accuracy by 4-8 percentage points over prompt-optimization baselines and enables selective prediction: the system can auto-handle the most confident half of cases at 95% precision, or the most confident quarter at 99% precision, while deferring lower-confidence cases for specialist review.

Although foundation models have achieved remarkable success in general domains, applying them to electroencephalography (EEG) analysis is constrained by substantial data requirements and large parameter counts, which incur prohibitive computational costs and impede deployment in resource-constrained clinical environments. General-purpose automated machine learning frameworks are likewise ill-suited to this domain, since exploration within an unbounded programmatic space fails to incorporate essential neurophysiological priors and frequently yields neuroscientifically implausible solutions. We therefore propose NeuroWeaver, a unified autonomous evolutionary agent that generalizes across diverse EEG datasets and tasks by reformulating pipeline engineering as a discrete constrained optimization problem solved through large language model (LLM)-driven generation of executable code. A Domain-Informed Subspace Initialization confines the search to a neuroscientifically plausible manifold, while a Multi-Objective Evolutionary Optimization dynamically balances performance, novelty, and efficiency via self-reflective refinement. Across five heterogeneous benchmarks, NeuroWeaver synthesizes lightweight pipelines that outperform state-of-the-art task-specific methods on nearly all metrics and attain accuracy comparable to large-scale foundation models, even surpassing them on the HMC and Workload benchmarks with only $0.18$M and $0.011$M parameters, respectively.

Neuromorphic and edge computing research has focused on reducing the inference cost of neural network controllers, yet in physical closed-loop systems the actuator can rival or exceed an efficient controller in energy. An efficient controller is therefore necessary but not sufficient, because the actuator becomes the cost worth reducing once inference no longer dominates it. Here, we introduce energy-aware learning, an approach that incorporates actuator energy directly into the reinforcement learning reward, and demonstrate it in closed-loop deep brain stimulation (DBS) for Parkinson's disease. A deep spiking Q-network, trained in a biophysical cortico-basal ganglia-thalamic circuit model, learns to suppress pathological alpha-beta oscillations by 45.2% while reducing stimulation charge by 80.0% relative to continuous DBS. Sparsity-constrained knowledge distillation compresses the policy onto the SynSense XyloAudio 3 neuromorphic processor at 0.52 mW inference power, yielding 28.1x lower energy per inference than an equivalent artificial neural network on conventional edge hardware. By co-optimizing stimulation energy and inference efficiency, the framework addresses both major power demands in implantable neuromodulation.