Two types of clinical forms of catatonia are established, systematic and periodic catatonia.2 Systematic catatonia is responsive to benzodiazepine and ECT; however, periodic catatonia is poorly responsive to these two therapies,2 similar to our case. Antipsychotic monotherapy with aripiprazole, olanzapine, quetiapine or risperidone was not effective; however, zonisamide could prevent the period of periodic catatonia without affecting catatonic stupor. Adding aripiprazole, which did not affect period of periodic catatonia by itself, to zonisamide drastically improved catatonic stupor. Therefore, the combination of zonisamide with aripiprazole drastically improved both period and symptoms of periodic catatonia. Several clinical studies reported the wide clinical spectrum of antiepileptic antiparkinsonian agent, zonisamide, against both psychiatric and neurological disorders, including Parkinson’s disease.3,4 The major mechanisms of clinical action of zonisamide are considered to be an inhibition of voltage-gated sodium channel, monoamine oxidase, ryanodine receptor and radical scavenging action.3 Aripiprazole has unique receptor binding profiles, high affinity with partial agonistic properties against dopamine D2 receptor.5 This successful treatment of combination therapy of zonisamide and aripiprazole against benzodiazepine- and ECT-resistant periodic catatonia suggests that the synergy between neuroprotective and enhanced dopaminergic transmission contribute to the improvement of both period and symptom of periodic catatonia.