Explainable Interictal Epileptiform Discharge Detection Method Based on Scalp EEG and Retrieval-Augmented Generation

The detection of interictal epileptiform discharge (IED) is crucial for the diagnosis of epilepsy, but automated methods often lack interpretability. This study proposes IED-RAG, an explainable multimodal framework for joint IED detection and report generation. Our approach employs a dual-encoder to extract electrophysiological and semantic features, aligned via contrastive learning in a shared EEG-text embedding space. During inference, clinically relevant EEG-text pairs are retrieved from a vector database as explicit evidence to condition a large language model (LLM) for the generation of evidence-based reports. Evaluated on a private dataset from Wuhan Children's Hospital and the public TUH EEG Events Corpus (TUEV), the framework achieved balanced accuracies of 89.17\% and 71.38\%, with BLEU scores of 89.61\% and 64.14\%, respectively. The results demonstrate that retrieval of explicit evidence enhances both diagnostic performance and clinical interpretability compared to standard black-box methods.