Background: Paroxysmal dyskinesias (PD) are rare, episodic movement disorders in children characterized by sudden, transient involuntary movements with preserved consciousness. In resource-limited Sub-Saharan Africa, they are frequently underrecognized and misdiagnosed as epilepsy due to overlapping clinical features and limited diagnostic capacity, resulting in inappropriate management and avoidable morbidity. Aim: To provide a comprehensive narrative overview of pediatric PD, with emphasis on clinical features, diagnostic challenges, and misdiagnosis as epilepsy in resource-constrained Sub-Saharan African settings. Methods: A narrative review of published literature was conducted using electronic databases, including MEDLINE, ScienceDirect, Google Scholar, and World Health Organization resources. Eligible studies included descriptive, observational, and review articles addressing pediatric PD, diagnostic challenges, and health-system factors. Findings were synthesized qualitatively. Data Synthesis: Paroxysmal dyskinesias typically present with stereotyped, trigger-induced episodes of dystonia or choreoathetosis, preserved awareness, and normal interictal neurological function. Misdiagnosis as epilepsy is common, driven by clinical overlap, high epilepsy prevalence, limited access to EEG, neuroimaging, and genetic testing, and low clinician awareness. Diagnostic delays are frequent, leading to unnecessary long-term antiepileptic therapy, financial burden, and psychosocial stigma. However, accurate diagnosis is achievable through careful clinical assessment, recognition of triggers, and use of pragmatic tools such as caregiver-recorded videos. Management is generally effective, combining low-dose pharmacotherapy, trigger avoidance, and supportive care. Conclusion: Strengthening clinical awareness, improving diagnostic capacity, and adopting low-cost, context-appropriate strategies are essential to reduce misdiagnosis and improve outcomes for children with PD in resource-limited settings.