The strength of coupling between epileptiform spike phase and ripple amplitude is positively correlated with mean ripple amplitude and negatively correlated with mean ripple frequency. In recordings from macroelectrodes in the SOZ, the presence of coupling between epileptiform phase and ripple amplitude (PAC) was associated with a greater mean normalized ripple amplitude (A1), and a decreased mean ripple frequency (A2)(student’s unpaired t-test, n=93,54 electrodes, p<0.01, error bars=s.e.m). (B) Among the recordings from macroelectrodes in the SOZ that exhibited PAC the strength of coupling was associated with increased mean normalized ripple amplitude (B1, R2=0.0742, df=92, p<0.01), and decreased mean ripple frequency (B2, R2=0.053, df=92, p<0.05). (C) Illustrative examples of mean ripple triggered averaged waveforms prior to (bottom) and after band-pass filtering (80–200 Hz) top demonstrating relationship between modulation strength and ripple amplitude and frequency.