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The orbitofrontal cortex (OFC) is proposed to arbitrate approach\u2013avoidance decisions, yet little is known about the real-time computations within OFC during these decisions. We conducted intracranial recordings in humans implanted with stereotactic electroencephalography electrodes in the OFC while they played a gamified approach\u2013avoidance task. Here we identified two anatomically distinct signals within the OFC prior to approach: an increase in activity within the medial compartment and a decrease within the lateral compartment. Prior to decisions, these signals rapidly alternated between discrete pro-approach and pro-avoidant states, thus introducing a new functional architecture within the human OFC during decision-making.<\/jats:p>","DOI":"10.1038\/s41593-026-02444-4","type":"journal-article","created":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T09:03:40Z","timestamp":1789463020000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Intracranial recordings in humans reveal differential contributions of medial and lateral orbitofrontal cortex to approach\u2013avoidance decision-making"],"prefix":"10.1038","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7772-5363","authenticated-orcid":false,"given":"Clara Kwon","family":"Starkweather","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4625-5642","authenticated-orcid":false,"given":"Ethan H.","family":"Willbrand","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0517-2296","authenticated-orcid":false,"given":"Kristin","family":"Sellers","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick W.","family":"Hullett","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6702-781X","authenticated-orcid":false,"given":"Andrew D.","family":"Krystal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A. 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