General vision-language models read EEG directly: Qwen3-VL hits 0.835 balanced accuracy on 4-second discharge detection without EEG pretraining
Clinical EEG reading has long depended on experts paging through recordings, while recent EEG foundation models first pretrain on large unlabeled EEG corpora. This work renders EEG segments as the bipolar montage waveforms or spectrograms clinicians already inspect, pairs each image with a fixed text prompt, and hands it to a general vision-language model, Qwen3-VL, with no EEG pretraining at all. On the 4-second interictal epileptiform discharge task vEpiSet, Qwen3-VL-4B adapted with LoRA reaches 0.835 balanced accuracy against 0.763 for fully fine-tuned BIOT; on the TUEV EEG-Bench split, Qwen3-VL-8B reaches 0.750 against 0.739 for the second-best single-task model.