What is the cause of Angela Merkel’s shaking fits?

Angela Merkel’s health is back in the spotlight after the German chancellor was seen shaking during a public appearance for the third time in as many weeks.

Merkel, who turns 65 next week, appeared to tremble uncontrollably as she stood with Finnish Prime Minister Antti Rinne during military honours in Berlin to mark his visit.

The chancellor was able to regain her composure after “an extended period of time”, says German newspaper Deutsche Welle, which claims that “Wednesday’s incident was not as severe as the prior cases”.

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Last month, Merkel was filmed “gripping her arms as her body was shaking” while attending an event with German President Frank-Walter Steinmeier, CNN reports. At one point, she was offered a glass of water, which she rejected, before the shaking subsided after several minutes.

The Daily Telegraph notes that the German leader was first seen shaking during a similar incident eight days earlier, on 18 June, when she was caught on film “desperately trying to maintain composure as she shook from head to foot” at a reception for Ukrainian President Volodymyr Zelensky in the German capital.

Merkel later claimed her shakes were the result of dehydration after standing in the hot sun throughout the ceremony, and said she had felt better after drinking water.

No explanation has been given for the more recent incident. At a press conference alongside PM Rinne, the German leader insisted simply that she was “fine,” reports Sky News.

“People don’t need to worry about me,” Merkel said, adding that she is still in a “processing phase” after her first shaking spell mid-June. “This is apparently not yet completely finished, but progress has been made.”

German media has noted that the chancellor is “always accompanied on major international trips by a doctor”, says The Local.

Merkel experienced a similar onset of trembling in 2017 while in Mexico City for a state visit. And in 2014, she postponed a television interview at the last minute amid reports that she was feeling weak and faint.

Some sources have speculated that she may be suffering from Parkinson’s disease, a condition that usually causes uncontrollable tremors.

However, the BBC reports that “leading Bavarian GP” Jakob Berger has cast doubt on that theory, saying her trembling had been more pronounced than is typical with Parkinson’s.

Fellow specialist Dr Christoph Specht argues that the chancellor may have contracted an infection, as “shivering indicated an infection that was flaring up again”, the broadcaster adds.

Meanwhile, GP and medical nutritionist Dr Sarah Brewer told the Daily Mail that the shaking might be caused by an overactive thyroid, which is ten times more common among women than men.

The shaking might also a side effect of medication, Brewer added.

However, other medical experts say the shaking could be connected to an emotional trigger.

The Times’ medical correspondent, Dr Mark Porter, points to “essential tremor”, a neurological disorder.

“Essential tremor often starts in the arms and may be intermittent at first, typically gradually spreading to other parts of the body including the head and tongue,” Porter writes.

“The shaking is generally aggravated by stress, embarrassment, anger, fatigue and hunger, and relieved by sleep and alcohol.”

In the past, Merkel has joked that she could manage for days on just a few hours of sleep as long as she had a decent rest at the weekend, calling herself a “sleep camel”.