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We hypothesized that the nocturnal synchronization of hippocampal ripples and cortical delta power could be used to classify epileptogenic and physiological ripples in the hippocampus.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We enrolled 38 patients with electrodes implanted in the hippocampus or parahippocampal gyrus between April 2014 and March 2023 at our institution. We divided 11 patients (11 hippocampi) who were pathologically diagnosed with hippocampal sclerosis into the EP group and five patients (six hippocampi) with no epileptogenicity in the hippocampus into the nonepileptogenic (NE) group. Hippocampal ripples were detected using intracranial electroencephalography with hippocampal or parahippocampal electrodes. Cortical delta power (0.5\u20134\u2009Hz) was assessed using cortical electrodes. The Pearson correlation coefficient between the ripple rates and cortical delta power (Corr\u2010RD) was calculated on the basis of the intracranial electroencephalographic signals recorded each night.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Although hippocampal ripples were similar among the EP and NE groups based on their waveforms and frequency properties, the Corr\u2010RDs in the EP group (mean [standard deviation]: 0.20 [0.049]) were significantly lower than those in the NE group (0.67 [0.070]). On the basis of the minimum Corr\u2010RDs, the two groups were classified with 94.1% accuracy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Interpretation<\/jats:title><jats:p>Our results demonstrate that the Corr\u2010RD is a biomarker of hippocampal epileptogenicity.<\/jats:p><\/jats:sec>","DOI":"10.1002\/acn3.70032","type":"journal-article","created":{"date-parts":[[2025,3,20]],"date-time":"2025-03-20T11:23:46Z","timestamp":1742469826000},"page":"986-997","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Abnormal Synchronization Between Cortical Delta Power and Ripples in Hippocampal Sclerosis"],"prefix":"10.1002","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2533-0551","authenticated-orcid":false,"given":"Takamitsu","family":"Iwata","sequence":"first","affiliation":[{"name":"Department of Neurosurgery Graduate School of Medicine, Osaka University  Suita Osaka 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of Tokyo  Tokyo Japan"},{"name":"Institute for AI and Beyond The University of Tokyo  Tokyo Japan"},{"name":"National Institute of Information and Communications Technology, Center for Information and Neural Networks  Suita Osaka Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Satoru","family":"Oshino","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Graduate School of Medicine, Osaka University  Suita Osaka Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Naoki","family":"Tani","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Graduate School of Medicine, Osaka University  Suita Osaka Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4039-0520","authenticated-orcid":false,"given":"Hui Ming","family":"Khoo","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Graduate School of Medicine, Osaka University  Suita Osaka 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