NeuroNTP - A Generalizable Multimodal Foundation Model for Epilepsy

Epilepsy affects approximately $1$% of the global population, where seizure detection and reliable forecasting are critical for patient safety and quality of life. While emerging foundation models increasingly recast EEG analysis as a language modeling task, most remain confined to single-modality inputs and narrow domain generalization. In this work, we present NeuroNTP, a modular multimodal foundation model built on an xLSTM backbone and pretrained on one of the largest retrospective epilepsy datasets ever collected, comprising $150,000$ hours of neural (EEG) and physiological (ECG, SpO$_2$) signals paired with rich clinical text. NeuroNTP employs a flexible, montage-geometry grounded tokenizer and optimizes a composite objective, synergizing causal next-token prediction with seizure-specific auxiliary tasks to enable unified sequence modeling across heterogeneous modalities. This approach allows the model to capture long-range temporal dependencies and cross-modal interactions that unimodal baselines ignore. In extensive experiments, we show that NeuroNTP outperforms supervised baselines by a substantial margin on held-out clinical cohorts. Furthermore, the model generalizes to public EEG benchmarks such as CHB-MIT and Siena Scalp EEG, achieving state-of-the-art performance under standard evaluation settings. We release code and model weights to facilitate further research.