CViT-ESP: Lightweight Pre-trained Vision Transformers for EEG-based Epileptic Seizure Prediction

Background and Objective Epileptic seizure prediction is a critical challenge requiring the discrimination of subtle preictal physiological changes from interictal brain activity. While deep learning has shown promise in this domain, existing models often face limitations due to small EEG datasets, high computational costs for training from scratch, and a lack of patient-independent generalizability. In this paper, we present a novel framework for EEG-based seizure prediction that leverages pre-trained Vision Transformers (ViTs) through custom architectural modifications and optimized re-training strategies. Methods Our primary contributions include: [bullet]CVIT-ESP: A family of vision transformer architectures that replaces standard patch embedding layers with custom N-dimensional CNN stages to refine EEG representations. [bullet] ESPFormer: A lightweight, custom-designed transformer specifically engineered to mitigate overfitting on limited-scale EEG datasets. We identified optimal fine-tuning combinations for transformer blocks by devising a heuristic search-space reduction strategy, significantly reducing the training complexity. We validated our methods using the patient-independent MLSPred-Bench, involving 12 diverse benchmarks with varying seizure prediction horizons. Results Results demonstrate a clear progression in performance: while prior ResNet and vanilla Transformer models achieved an AUC-ROC of 69.0%, our CVIT-ESP architectures achieved the highest performance with a maximum average AUC of 76.4%. Conclusions These findings suggest that adapting pre-trained ViTs with domain-specific CNN front-ends and strategic fine-tuning offers a robust, generalizable, and resource-efficient path forward for clinical seizure prediction systems. Our code is available at: https://github.com/pcdslab/CVitEsp and https://github.com/pcdslab/ESPFormer