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Reduced medullary serotonergic neurones, modulators of respiration in response to hypercapnia, were reported in a SUDEP post\u2010mortem series. The amygdala and hippocampus have high serotonergic innervation and are functionally implicated in seizure\u2010related respiratory dysregulation. We explored serotonergic networks in mesial temporal lobe structures in a surgical and post\u2010mortem epilepsy series in relation to SUDEP risk. We stratified 75 temporal lobe epilepsy patients with hippocampal sclerosis (TLE\/HS) into high (<jats:italic>N<\/jats:italic>\u00a0=\u200916), medium (<jats:italic>N<\/jats:italic>\u00a0=\u200911) and low risk (<jats:italic>N<\/jats:italic>\u00a0=\u200948) groups for SUDEP based on generalised seizure frequency. We also included the amygdala in 35 post\u2010mortem cases, including SUDEP (<jats:italic>N<\/jats:italic>\u00a0=\u200917), epilepsy controls (<jats:italic>N<\/jats:italic>\u00a0=\u200910) and non\u2010epilepsy controls (<jats:italic>N<\/jats:italic>\u00a0=\u20098). The immunohistochemistry labelling index (LI) and axonal length (AL) of serotonin transporter (SERT)\u2010positive axons were quantified in 13 regions of interest with image analysis. SERT LI was highest in amygdala and subiculum regions. In the surgical series, higher SERT LI was observed in high risk than low risk cases in the dentate gyrus, CA1 and subiculum (<jats:italic>p<\/jats:italic>\u00a0&lt;\u20090.05). In the post\u2010mortem cases higher SERT LI and AL was observed in the basal and accessory basal nuclei of the amygdala and peri\u2010amygdala cortex in SUDEP compared to epilepsy controls (<jats:italic>p<\/jats:italic>\u00a0&lt;\u20090.05). Patients on SRI showed higher SERT in the dentate gyrus (<jats:italic>p<\/jats:italic>\u00a0&lt;\u20090.005) and CA4 (<jats:italic>p<\/jats:italic>\u00a0&lt;\u20090.05) but there was no difference in patients with or without a psychiatric history. Higher SERT in hippocampal subfields in TLE\/HS cases with SUDEP risk factors and higher amygdala SERT in post\u2010mortem SUDEP cases than epilepsy controls supports a role for altered serotonergic networks involving limbic regions in SUDEP. This may be of functional relevance through reduced 5\u2010HT availability.<\/jats:p>","DOI":"10.1111\/bpa.13074","type":"journal-article","created":{"date-parts":[[2022,4,28]],"date-time":"2022-04-28T06:55:59Z","timestamp":1651128959000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Serotonin transporter in the temporal lobe, hippocampus and amygdala in <scp>SUDEP<\/scp>"],"prefix":"10.1111","volume":"32","author":[{"given":"Smriti","family":"Patodia","sequence":"first","affiliation":[{"name":"Department of clinical and experimental epilepsy UCL Queen Square Institute of Neurology  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alyma","family":"Somani","sequence":"additional","affiliation":[{"name":"Department of clinical and experimental epilepsy UCL Queen Square Institute of Neurology  London 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