Peer-Reviewed Publication
Lancet Digit Health2026;101039.August 25, 2026Journal Article
Toward unified and comprehensive automated electroencephalogram interpretation: a multicentre development and validation of an electroencephalogram foundation model.
Chenxi Sun1, Ioannis Karakis2, Aline Herlopian3, Marcus C Ng4, Gamaleldin Osman5, Zubeda Sheikh6, Olga Taraschenko7, Ji Yeoun Yoo8, Brian L Appavu9, Lakshman Arcot Jayagopal7, Peter W Kaplan10, Jong Woo Lee11, Olga Selioutski12, Hiba A Haider13, Jonathan J Halford14, Daniel B Hoch15, Alice Lam15, Fabio A Nascimento16, Jay Pathmanathan17, Sarah Schmitt18, Pia De Stefano19, Uwrs Fisch20, Jeroen Gijs21, Humberto Castro-Lima22, Wan-Yee Kong23, Mackenzie C Cervenka10, Monica B Dhakar24, Safoora Fatima25, Nicolas Gaspard26, Emily J Gilmore3, Susan T Herman27, Manisha G Holmes28, Emily L Johnson10, Carlos F Muniz29, Eric S Rosenthal15, Andres A Rodriguez Ruiz30, Rani A Sarkis11, Mouhsin M Shafi23, Christa B Swisher31, Mohammad Tabaeizadeh32, Selim R Benbadis33, Fonda Chan34, Catherine J Chu15, Marjan Dolatshahi35, Adam S Greenblatt16, Roohi Katyal36, Chinasa Nwankwo37, Edilberto Amorim38, William O Tatum39, Dan Weber40, Tobias Loddenkemper41, Jurriaan M Peters41, Umakanth Katwa41, Kiran Maski41, Robert Joseph Thomas23, Shenda Hong42, Doyle Yuan43, Sydney S Cash23, Andrew J Cole15, Daniel M Goldenholz23, Charlotte Stow44, Jennifer A Kim3, Sahar F Zafar15, Aaron F Struck25, M Brandon Westover45, Jin Jing23
1Beth Israel Deaconess Medical Center, Boston, MA, USA; Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Palo Alto, CA, USA. Electronic address: cxsun@stanford.edu.
2Emory University School of Medicine, Atlanta, GA, USA; University of Crete School of Medicine, Heraklion, Greece.
3Yale School of Medicine, New Haven, CT, USA.
4University of Manitoba, Winnipeg, MB, Canada.
5Mayo Clinic-Rochester, Rochester, MN, USA.
6Virginia Commonwealth University, Richmond, VA, USA.
7University of Nebraska Medical Center, Omaha, NE, USA.
8Icahn School of Medicine, New York, NY, USA.
9University of Arizona College of Medicine, Phoenix, AZ, USA.
10Johns Hopkins School of Medicine, Baltimore, MD, USA.
11Brigham and Women's Hospital, Boston, MA, USA.
12Stony Brook University, Stony Brook, NY, USA.
13University of Chicago, Chicago, IL, USA.
14Ralph H Johnson Veterans Affairs Medical Center, Charleston, SC, USA.
15Massachusetts General Hospital, Boston, MA, USA.
16Washington University in St Louis, St Louis, MO, USA.
17Beacon Biosignals/Boston VA Healthcare, Boston, MA, USA.
18Medical University of South Carolina, Charleston, SC, USA.
19University Hospital of Geneva, Geneva, Switzerland.
20Brigham and Women's Hospital, Boston, MA, USA; University Hospital Basel, Basel, Switzerland.
21Department of Neurosciences, Experimental Neurology, Laboratory for Epilepsy Research, KU Leuven, Leuven Brain Institute, Leuven, Belgium; Division of Neurology, University Hospitals Leuven, Leuven, Belgium.
22Bahiana School of Medicine and Public Health, Salvador, Brazil.
23Beth Israel Deaconess Medical Center, Boston, MA, USA.
24Warren Alpert School of Medicine of Brown University, Providence, RI, USA.
25University of Wisconsin-Madison, Madison, WI, USA.
26Belgium University Libre de Bruxelles, Hopital Universitaire de Bruxelles - Hopital Erasme, Brussels, Belgium.
27Barrow Neurological Institute, Phoenix, AZ, USA.
28Westchester Medical Center, New York Medical College, Valhalla, NY, USA.
29SUNY Upstate Medical University, Syracuse, NY, USA.
30Emory University School of Medicine, Atlanta, GA, USA.
31Atrium Health, Charlotte, NC, USA.
32University of Texas Southwestern, Dallas, TX, USA.
33University of South Florida, Tampa, FL, USA.
34Neurology Consultants of Dallas, Dallas, TX, USA.
35William Osler Health System, Brampton, ON, Canada.
36Louisiana State University Health Shreveport, Shreveport, LA, USA.
37Akron Children's Hospital, Akron, OH, USA.
38University of California San Francisco, San Francisco, CA, USA.
39Mayo Clinic Florida, Jacksonville, FL, USA.
40St Louis University, St Louis, MO, USA.
41Boston Children's Hospital, Boston, MA, USA.
42National Institute of Health Data Science, Peking University, Beijing, China.
43Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA; Peter O'Donnell Jr Brain Institute, University of Texas Southwestern Medical Center, Dallas, TX, USA.
44Trustee TeleEEG, London, UK.
45Beth Israel Deaconess Medical Center, Boston, MA, USA; Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Palo Alto, CA, USA.
Abstract
BACKGROUND: Electroencephalogram (EEG) interpretation is essential for neurological diagnosis, but expert interpretation is limited globally, and existing AI methods address narrow tasks. This study aimed to develop and externally validate a broadly applicable foundation model capable of expert-level performance across diverse EEG tasks and clinical settings.
METHODS: In this multicentre study we…
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