CLEF: EEG Foundation Model for Learning Clinical Semantics

Clinical EEG interpretation requires reasoning over full EEG sessions and integrating signal patterns with clinical context. Existing EEG foundation models are largely designed for short-window decoding and do not incorporate clinical context. We introduce CLEF, a clinically grounded long-context EEG foundation model. CLEF represents EEG sessions as 3D multitaper spectrogram tokens, enabling tractable Transformer modeling at session scale, and aligns embeddings with neurologist reports and structured EHR data through contrastive objectives. We evaluate CLEF on a new 234-task benchmark spanning disease phenotypes, medication exposures, and EEG findings, with more than 260k EEG sessions from over 108k patients. CLEF outperforms prior EEG foundation models on 229 of 234 tasks, improving mean AUROC from 0.65 to 0.74. Reconstruction-only pretraining surpasses prior EEG foundation models, while report and EHR alignment yields further gains. Held-out concept and external-cohort experiments suggest that these representations transfer beyond observed alignment targets. These results support session-scale, clinically grounded representation learning as a promising foundation-model paradigm for clinical EEG.

Physiology as Language: Translating Respiration to Sleep EEG

This paper introduces a novel cross-physiology translation task: synthesizing sleep electroencephalography (EEG) from respiration signals. To address the significant complexity gap between the two modalities, we propose a waveform-conditional generative framework that preserves fine-grained respiratory dynamics while constraining the EEG target space through discrete tokenization. Trained on over 28,000 individuals, our model achieves a 7% Mean Absolute Error in EEG spectrogram reconstruction. Beyond reconstruction, the synthesized EEG supports downstream tasks with performance comparable to ground truth EEG on age estimation (MAE 5.0 vs. 5.1 years), sex detection (AUROC 0.81 vs. 0.82), and sleep staging (Accuracy 0.84 vs. 0.88), significantly outperforming baselines trained directly on breathing. Finally, we demonstrate that the framework generalizes to contactless sensing by synthesizing EEG from wireless radio-frequency reflections, highlighting the feasibility of remote, non-contact neurological assessment during sleep.