# Neurostimulation in the Middle East: What Do We Know So Far? A Narrative Review

## TL;DR

This review explores the use of neurostimulation therapies like ECT and rTMS in the Middle East, highlighting limited access, stigma, and the need for region-specific strategies.

## Contribution

The paper provides a narrative review of neurostimulation in the MENA region, emphasizing regional disparities and barriers to adoption.

## Key findings

- ECT is more established than rTMS in the MENA region.
- Public awareness of neurostimulation remains low, and stigma persists.
- rTMS is gaining clinical interest but is limited by cost and infrastructure.

## Abstract

Mental health disorders are increasingly being recognized as a major global challenge. In the Arabic-speaking Middle East and North Africa (MENA) region, this challenge is compounded by sociocultural stigma, political instability, and limited mental health infrastructure, all of which restrict access to effective care. While neurostimulation modalities such as electroconvulsive therapy (ECT) and repetitive transcranial magnetic stimulation (rTMS) have proven effective and are gaining traction, their use in the MENA region remains limited and underexplored. This narrative review aims to bridge critical gaps by examining knowledge levels, attitudes, perceptions, and the clinical application and accessibility of ECT and rTMS across Arabic-speaking countries. We searched multiple databases using keywords related to neurostimulation and psychiatry, covering all 22 Arabic-speaking MENA countries. Studies were included if they were published in English and were related to psychiatric applications of ECT or rTMS. Findings were categorized by geography and grouped into four thematic domains: knowledge, perception, availability, and clinical use. The findings revealed an uneven distribution of neurostimulation research and services across the region; ECT is more established than rTMS. Additionally, public awareness remains low, and high levels of stigma persist. Among clinicians, psychiatrists tend to support neurostimulation, while general medical staff show mixed opinions. rTMS is gaining clinical interest but remains limited in accessibility due to high costs and limited infrastructure. Although neurostimulation should be more widely implemented in psychiatry in the MENA region, it is still underrecognized and underused. Region-specific strategies addressing stigma, training gaps, and policy standardization are essential to optimize neurostimulation use and its public acceptance.