EEG Seizure Detection

Large-scale EEG foundation models have demonstrated promising transferability across neurological disorders, but often require millions of parameters and substantial computational resources. In this paper, we present the Universal Semantic EEG Foundation Model (USE-FM), a lightweight EEG foundation model that learns transferable neural representations through self-supervised signal reconstruction on the Temple University Hospital EEG Corpus (TUEG). After pretraining, the encoder is frozen and evaluated on two clinically distinct downstream tasks, abnormal EEG detection (TUAB) and epileptic seizure recognition (TUEP), using a unified frozen-transfer protocol against recent EEG foundation models, including LUNA-Base and CBraMod. With only 1.46 million parameters, approximately one-fifth the size of existing models, USE-FM achieves competitive overall performance, including strong sensitivity and F1-score on TUEP (SEN $75.00 \pm 14.14$, F1 $70.37 \pm 4.01$), while maintaining competitive performance on TUAB (AUC $85.24 \pm 5.61$). Beyond downstream classification, latent representation analysis using $k$-means clustering together with PCA and t-SNE demonstrates that USE-FM learns organized semantic EEG representations comparable to substantially larger foundation models. These results suggest that large-scale self-supervised pretraining enables lightweight architectures to learn transferable semantic EEG representations, providing a computationally efficient foundation for cross-disorder analysis and future clinical decision support in neurological disorders.

Electroencephalography (EEG) is recorded continuously over hours, with relevant dynamics spanning timescales from milliseconds to hours. Most EEG foundation models nevertheless process fixed windows independently, limiting their ability to capture information encoded in long-timescale dynamics. State-space architectures enable persistent recurrent processing, but long-range information remains implicitly compressed in recurrent states. We present NeurDuo-EEG, a causal EEG foundation model with channel-resolved persistent memory. NeurDuo-EEG introduces multi-timescale memory management with learned consolidation and selective retrieval, enabling persistent modelling of continuous EEG with fixed-size state. It is pre-trained on 3,955 hours of EEG from 17 public datasets using multichannel autoregressive prediction of discrete spectral codes. Across three short-window and two long-sequence downstream tasks, NeurDuo-EEG achieves the best performance on four of five benchmarks, including all three short-window tasks and seizure detection, where AUC-PR improves from $0.285$ to $0.471$ over the strongest non-NeurDuo baseline. NeurDuo-EEG also remains competitive on sleep staging and supports efficient streaming inference, with nearly constant per-chunk latency as the available history grows to one hour. Notably, the Small variant achieves this with only 4.7M backbone parameters. These results demonstrate the value of persistent, multi-timescale modelling for both long-sequence and short-window EEG analysis. Our code is available at https://github.com/YifaNNW/NeurDuo-EEG.

Seizure detection and prediction from EEG are clinically important but challenging because seizures are rare, temporally localized, and propagate as coordinated events across multiple channels. Recent dynamic graph neural networks model this by running a temporal model over a sequence of per-time-step pairwise channel edges. However, this pairwise construction misses the spatiotemporal coupling that constitutes a seizure, at substantial training cost. We propose HyBrain, which summarizes spatiotemporal EEG evidence through a small set of soft hyperedges rather than pairwise edges. A per-channel Mamba backbone produces one token per (channel, second), and a spatiotemporal hyperedge block pools these tokens into E_h shared group embeddings through soft memberships and broadcasts them back. The same encoder serves three downstream tasks: window-based detection, one-second point-wise detection, and preictal seizure prediction. On TUSZ and CHB-MIT, HyBrain achieves the best AUROC on every reported setting against ten baselines, with the largest gap on long-clip preictal prediction. It also matches the most efficient baselines in training time and peak GPU memory. A qualitative analysis shows that even a single learned hyperedge cleanly captures the preictal -> ictal -> postictal trajectory on a real seizure clip.

Clinicians and neuroscientists have long analyzed intracranial electroencephalography (iEEG) through directly measurable physiological characteristics, which carry much of the information that downstream tasks depend on. Recent iEEG foundation models learn by reconstructing or predicting their inputs, which leaves the retention of these characteristics implicit. They are also evaluated mainly on cognitive decoding and a narrow clinical task, i.e., seizure detection. On a broad, clinically relevant benchmark such as Omni-iEEG, they remain below task-specific models when used frozen. We introduce PHASE, a physiology-guided foundation model that makes these characteristics explicit learning targets, pairing them with masked latent prediction in a temporal stage (PHASE-T) within each channel and a spatiotemporal stage (PHASE-ST) across synchronized channels. PHASE is pretrained on heterogeneous recordings from 222 participants at nine clinical sites. On all five Omni-iEEG clinical tasks, frozen PHASE-T outperforms every evaluated foundation model by up to 31%, and fine-tuned PHASE-T surpasses the task-specific models, setting a new state of the art. PHASE-T benefits from physiological supervision, outperforming variants trained with latent prediction alone or auxiliary waveform reconstruction on every task in matched ablations. PHASE-T generalizes to unseen institutions, outperforming the compared models with few or no local labels. PHASE-ST further improves seizure-onset-zone identification over PHASE-T and, when frozen, decodes sound volume and pitch on BrainTreebank better than published models. Beyond task performance, PHASE learns to encapsulate the physiological characteristics clinicians recognize, from seizure onset and its propagation to anatomical region identity, even though its pretraining contains no ictal recordings or anatomical labels.

Learning robust representations for time-series signals under noise and distribution shifts remains challenging, especially in clinical applications such as electroencephalogram (EEG) and electrocardiogram (ECG) analysis. We propose Diffusion-Conditioned Representation Alignment (DCRA), a training framework that repurposes the forward diffusion process as a structured corruption scheduler for representation learning. Different from conventional augmentation and consistency-based methods that rely on independently sampled perturbations, DCRA introduces a structured corruption trajectory via the diffusion forward process, which enables continuous and controlled representation evolution across noise levels. We introduce a feature-level consistency objective that aligns representations across noise levels while preserving class-discriminative structure. This mechanism promotes structure-preserving consistency, which enables smooth and semantically coherent feature trajectories in latent space. The proposed framework is encoder-agnostic and can be integrated with state space models and Transformer architectures. The seizure detection experiments on the CHB-MIT EEG dataset show that DCRA consistently improves performance under multiple noise conditions and achieves higher sensitivity at low false-positive rates. Analysis reveals that DCRA produces more balanced and structured representations compared to baseline and diffusion-only models. These findings highlight the benefit of combining structured corruption with representation alignment for robust time-series learning.

Despite strong performance on held-out electroencephalography (EEG) data, seizure detectors may fail under real-world acquisition variability, artifacts, and adversarial inputs. We introduce RobustSeiz, an open-source, model-agnostic framework that provides a standardized, reproducible protocol for stress-testing and comparing seizure detectors under controlled, clinically motivated distribution shifts before deployment. We standardize four public scalp-EEG corpora (CHB-MIT, TUSZ, Siena, and SeizeIT1) into BIDS-EEG trees and evaluate subject-independent detectors on held-out splits. Environment, noise, and adversarial transforms are swept over predefined hyperparameter grids. Each run reports sample- and event-level sensitivity, precision, F1, false positives per 24 h, Lead and Lag onset timing, and Monte Carlo dropout predictive agreement. RobustSeiz includes a Dockerized GPU pipeline, experiment registry, and full-evaluation and research-subset modes. We demonstrate the framework with a contemporary seizure detector on TUSZ across the complete implemented shift grid; an AWGN analysis illustrates how perturbation severity changes detection quality, onset timing, and predictive agreement. RobustSeiz provides a shared benchmarking standard for evaluating seizure-detector robustness under realistic clinical stressors, extending pre-deployment assessment beyond clean-data accuracy.

Most existing seizure detection algorithms require extensive pre-processing of the data and rely on heuristic or currently unexplainable machine learning approaches. These approaches often struggle with balancing detection sensitivity and specificity in the presence of variable seizure morphologies, interictal epileptiform discharges, and artefacts. Here, we consider an alternative approach: our seizure detection algorithm, which is based on the concept of critical transitions and overcomes the aforementioned limitations. Specifically, we perform a receiver-operating-characteristic analysis to quantify the performance of our algorithm in terms of its agreement with expert annotations of seizure onset and offset times in the voltage recordings of seizure activity in epileptic rodents with different seizure morphologies. We demonstrate how performance depends on algorithm parameters and varies across different rodent recording sessions. We determine the optimal set of algorithm parameters for each recording session, with near expert-level performance achieved in most cases. Finally, we derive a single general set of algorithm parameters applicable across all recording sessions. The algorithm maintains its high performance in this general setting, demonstrating its versatility, robustness across varying seizure morphologies, and potential to complement machine learning algorithms.

Electroencephalography (EEG) models used for epilepsy are often limited to specific datasets and tasks. This limited approach can make it challenging to apply these models across different datasets or in various situations. However, recent studies in foundation models and self-supervised learning suggest that an adaptable EEG backbone could support a range of EEG related tasks. In this study, we have developed a multimodal EEG foundation model that combines a raw signal encoder based on the Mamba architecture, a Vision Transformer (ViT)-style encoder for time-frequency data, and a lightweight encoder for text, all within a shared embedding space. The pretraining process relies on several innovative techniques, such as masked modeling, cross-view contrastive alignment, and temporal consistency losses. These methods are designed to create rich, seizure-relevant representations without requiring labeled data. To assess the efficacy and generalization of our pretrained model, we fine-tuned it on the canonical CHB-MIT seizure detection benchmark and additional seizure detection datasets, and conducted extensive experiments comparing different model variants. On the standard CHB-MIT split, our best single model achieved an AUROC of 0.874, and an ensemble variant reached 0.878 AUROC, representing state-of-the-art performance on this benchmark. In addition to standard train-test splits, we evaluated performance under a leave-one-subject-out (LOSO) protocol, which is rarely reported in prior EEG seizure modeling work and highlights the difficulty of patient-independent seizure detection, with a mean LOSO balanced accuracy of 0.558 across 19 subjects. Across datasets and evaluation settings, our multimodal foundation model enabled robust seizure detection and straightforward adaptation to new seizure detection scenarios, while also supporting interpretable seizure localization.

Seizure diagnosis from EEG signals is a critical yet persistently challenging task, due to the complicated neural dynamics and the spurious connections in inter-channel modeling. While spatial-temporal graph neural networks (STGNNs) have advanced EEG brain network representation learning, the resulting graph structures suffer from low clinical plausibility and limited interpretability due to their purely data-driven nature. To this end, we introduce NeuroGRIP, a retrieval-augmented graph refinement framework that incorporates external medical knowledge to calibrate noisy EEG graphs. We first construct a large-scale, domain-specific knowledge base derived from authoritative clinical guidelines. Leveraging large language models, we extract structured biomedical entities and relations to form a textual knowledge graph (KG), which serves as external knowledge source of clinical priors. Our framework performs alignment-aware query construction by projecting STGNN-generated EEG node embeddings into the semantic space of KG. Semantic queries are then executed via FAISS-based similarity search over knowledge triplets to retrieve relation evidence. Each predicted edge is assigned a confidence score based on retrieved similarity, relation type, and source reliability, enabling us to prune medically implausible edges from the originally predicted graph. Extensive experiments on TUSZ and CHB-MIT demonstrate that NeuroGRIP not only improves seizure detection accuracy but also enhances interpretability by grounding each prediction in clinically validated knowledge. This work provides the first unified framework that tightly couples brain dynamics with external medical expertise via retrieval-augmented reasoning, paving the way for knowledge-enhanced, explainable clinical diagnosis. The code is available at: https://github.com/LincanLi-X/NeuroGRIP.

Deep learning for EEG-based seizure detection faces critical challenges: severe annotation scarcity and extreme class imbalance, where ictal events comprise less than 10% of clinical recordings. We present DiffEEG, a 9.6M-parameter self-supervised foundation model that addresses both limitations through denoising diffusion pre-training and reinforcement learning (RL)-based fine-tuning. Pre-trained on 1.3M unlabeled segments from the Temple University Hospital Seizure Corpus (TUHSZ), DiffEEG learns generic neural representations via a 1D U-Net with multi-head self-attention. For downstream adaptation, a reinforced decision layer employs policy gradient optimization to directly maximize F1-score, prioritizing sensitivity to rare seizure events over overall accuracy. Under strict patient-wise evaluation (279 patients, Leave-One-Fold-Out), DiffEEG achieves 61% accuracy and 59% F1 for 4-class seizure subtyping, and 81% accuracy with 85% weighted F1 for binary detection, maintaining clinically viable seizure recall (59%) despite extreme imbalance (6.7% prevalence). Segment-level evaluation establishes an upper bound of 97.6% accuracy, confirming strong architectural capacity. DiffEEG demonstrates that diffusion-based pre-training combined with metric-aware reinforcement learning enables clinically deployable seizure monitoring with minimal labeled data requirements.

Electroencephalogram (EEG) analysis remains the clinical gold standard for epilepsy diagnosis and seizure detection. While Deep Learning (DL) has significantly advanced automated EEG interpretation, its transition from controlled experimental settings to routine clinical deployment is severely bottlenecked by fundamental architectural flaws. Standard DL models operate as opaque black-boxes lacking clinical interpretability, demand massive amounts of balanced annotated data, and incur steep computational costs incompatible with resource-constrained wearable or implantable neuromodulation devices. This paper presents a comprehensive review of these prevailing limitations and explores Kolmogorov-Arnold Networks (KANs) as a emerging paradigm for EEG-based seizure detection. By replacing the fixed activation functions of traditional neurons with flexible, learnable functions along the network's connections, KANs bridge the critical gap between predictive accuracy and mathematical transparency. We systematically analyze how KAN architectures resolve the shortcomings of traditional DL-based models by offering exceptional parameter efficiency, inherent interpretability for physician trust, and robust performance under data scarcity. Ultimately, this review establishes KANs not merely as an incremental algorithmic update, but as a fundamental paradigm shift necessary to actualize next-generation, patient-specific, and thoroughly transparent clinical EEG monitoring systems.

Wearable healthcare devices are the fastest-growing Internet of Things (IoT) sector. Many automated healthcare services rely on two crucial biological signals, namely ECG and EEG, which reflect the activity of the heart and brain, respectively. Although deep neural networks are considered the primary way to process and analyze these signals, the very tight energy and computational power constraints in wearable devices are far below the computational, energy, and memory bandwidth demands of DNN models, thereby impeding the deployment of deep learning in many practical wearable services. This paper investigates the feasibility of deploying state-of-the-art DNN models in resource-constrained wearable devices. Notably, we explore the trade-off between accuracy and computational complexity of DNNs when parameter quantization and electrode reduction methods are used. Our investigation centers on several state-of-the-art DNN models designed for EEG signal analysis, specifically for detecting epileptic seizures. Our findings demonstrate that, when applied judiciously, these techniques can significantly reduce the complexity of the DNNs under consideration with minimal adverse effects on accuracy. These results reveal the explicit trade-offs between accuracy and complexity reduction encountered when adapting DNN-based online EEG analysis for wearable devices.

Epilepsy is one of the most common neurological disorders globally, characterized by recurring seizures and significantly impacting the quality of life. Despite advancements in diagnostic techniques, the mitigation of risks faced by epilepsy patients remains challenging due to the unpredictability of seizure events. An accurate forecast of seizure onset helps to reduce risks in epilepsy patients. In this paper, we propose EEG-FuseFormer, a transformer-based feature fusion framework for seizure-onset prediction that combines intermediate features extracted from Convolutional Neural Networks-Long Short-Term Memory (CNN-LSTM) and ResNet-18 networks. The CNN-LSTM architecture captures both spatial and temporal features directly from the raw signal, whereas the ResNet-18 extracts features from the Short-Time Fourier Transform (STFT) representation of the EEG signals. Fusion is carried out using a transformer encoder, and the final prediction is generated using fully connected dense layers. The CHB-MIT dataset was used to validate the proposed model. The results show that the proposed model achieves a mean recall of 98.85% and outperforms most of the state-of-the-art methods. This study evaluates the ability of the proposed feature fusion model to generalize in cross-patient testing scenarios. Fine-tuning pre-trained models on limited target patient data (target adaptation) within the cross-patient validation framework results in higher recall, precision, and F1-score metrics in comparison to the conventional cross-patient validation approach. Finally, the runtime-based computational complexity of the model is assessed across diverse hardware platforms to highlight the performance-complexity trade-off.

Reliable seizure prediction is a prerequisite for closed-loop neurostimulation therapy, yet existing methods rarely account for the variability in EEG signal quality encountered in real-world deployment, and the overwhelming majority adopt non-strict evaluation protocols that overestimate generalisation performance. We propose CLSP-REQA (Closed-Loop Seizure Prediction with Real-time EEG Quality Assessment), a unified framework that embeds a lightweight signal quality estimator directly within the prediction pipeline. A Real-time EEG Quality Assessment (REQA) module runs in parallel with a Mamba-BiLSTM backbone, producing a scalar quality score q in [0,1] that modulates output confidence through a tiered non-linear fusion function (ECLO). Under strict cross-patient evaluation on the CHB-MIT Scalp EEG Database (n = 23 subjects, 198 seizures), CLSP-REQA achieves an AUC-ROC of 0.7426 +- 0.0199, outperforming the unadapted cross-patient baseline of 0.69 reported by Jemal et al., using only 16 EEG channels compared to 23 in prior work, and without requiring any target-patient data or domain adaptation. On the SIENA Scalp EEG Database (n = 14 subjects, 47 seizures), CLSP-REQA achieves AUC 0.7012 +- 0.0249, substantially surpassing the best domain-adapted cross-patient result of 0.61 on the same dataset, demonstrating strong cross-dataset generalisation. The framework outputs a structured four-tuple (p, q, c, Phi_SHAP) directly compatible with closed-loop neurostimulator interfaces.

Electroencephalogram (EEG) signals are vital for automated seizure detection, but their inherent noise makes robust representation learning challenging. Existing graph construction methods, whether correlation-based or learning-based, often generate redundant or irrelevant edges due to the noisy nature of EEG data. This significantly impairs the quality of graph representation and limits downstream task performance. Motivated by the remarkable reasoning and contextual understanding capabilities of large language models (LLMs), we explore the idea of using LLMs as graph edge refiners. Specifically, we propose a two-stage framework: we first verify that LLM-based edge refinement can effectively identify and remove redundant connections, leading to significant improvements in seizure detection accuracy and more meaningful graph structures. Building on this insight, we further develop a robust solution where the initial graph is constructed using a Transformer-based edge predictor and multilayer perceptron, assigning probability scores to potential edges and applying a threshold to determine their existence. The LLM then acts as an edge set refiner, making informed decisions based on both textual and statistical features of node pairs to validate the remaining connections. Extensive experiments on TUSZ dataset demonstrate that our LLM-refined graph learning framework not only enhances task performance but also yields cleaner and more interpretable graph representations.

Reliable seizure detection in mouse models is essential for preclinical epilepsy research, yet manual review of synchronized video-EEG recordings is labor-intensive and single-modality systems fail for complementary reasons: video-based methods are easily confounded by benign behaviors, whereas EEG-based methods are vulnerable to ictal motion artifacts. We present EEGVFusion, a multimodal framework that combines self-supervised EEG representation learning, spatio-temporal video encoding, optimal-transport alignment, and bidirectional cross-attention to integrate neural and behavioral evidence. We also curate an expert-annotated dataset of synchronized EEG and video recordings comprising 93 sessions from 15 mice for training and evaluation. In the random-session split, EEGVFusion achieved a Balanced Accuracy of 0.9957 with perfect event sensitivity and an Event FAR of 0.6250 FP/h, indicating strong seizure detection performance with a low false-alarm burden. In a single held-out-subject evaluation with Subject 110 reserved for testing, EEGVFusion achieved a Balanced Accuracy of 0.9718 and reduced Event FAR from 2.7250 FP/h for the EEG-only counterpart to 0.4833 FP/h while preserving perfect event sensitivity. Targeted ablations further showed that EEG pre-training and OT alignment help reduce false alarms while preserving event sensitivity.

Electroencephalography (EEG) is a critical tool for monitoring brain activity and diagnosing neurological disorders such as epilepsy. However, learning meaningful representations from raw EEG signals remains challenging due to limited annotations, substantial inter-subject variability, and complex temporal dynamics. Recent EEG foundation models (FMs) have demonstrated promising performance through transformer-based architectures and large-scale self-supervised pretraining, yet they often incur substantial computational costs and exhibit diminishing returns with increasing model and dataset scale, limiting their practicality in clinical settings. To address these challenges, we propose EEGDM, a diffusion-based EEG representation learning framework. Specifically, EEGDM introduces a Structured State-Space Model for Diffusion Pretraining (SSMDP) that effectively captures long-range temporal dependencies through generative diffusion training on unlabeled EEG data. The representations are subsequently leveraged for downstream tasks via our Latent Fusion Module (LFM), which integrates multi-layer latent features of SSMDP. We evaluate EEGDM on three EEG benchmarks spanning EEG event classification (TUEV), seizure detection (CHB-MIT), and seizure classification (IIIC). Compared with existing state-of-the-art methods, including EEG FMs, EEGDM achieves competitive performance across diverse tasks and datasets, exceeding existing methods in most cases while requiring substantially fewer samples for both pretraining and downstream adaptation. These results demonstrate that diffusion-based learning can unlock more discriminative EEG representations, with direct implications for epilepsy diagnosis and management. Our source code and pretrained checkpoints are publicly available at: https://github.com/jhpuah/EEGDM.