{Reference Type}: Case Reports {Title}: From parasomnia to agrypnia excitata - An illustrative case on diagnostic approach. {Author}: Fong SL;Dy Closas AMF;Lim TT;Lean PL;Loh EC;Lim SY;Tan AH; {Journal}: Parkinsonism Relat Disord {Volume}: 109 {Issue}: 0 {Year}: 04 2023 {Factor}: 4.402 {DOI}: 10.1016/j.parkreldis.2023.105332 {Abstract}: The diagnostic approach to sleep-related movements disorders is seldom discussed. We report a case of fatal familial insomnia who initially presented with persistent limb movements in sleep, which later progressed to a state of agrypnia excitata. Here, the evaluation of abnormal movements in sleep is discussed using a step-by-step diagnostic approach. Although no cure is available for fatal familial insomnia, prompt recognition of this condition is important to facilitate proper management, including the involvement of interdisciplinary neuropalliative care.